Efficacy of popliteal plexus block for opioid sparing and pain management after lower extremity surgery: a meta-analysis
In brief
Add-on popliteal block cut postoperative nausea and vomiting by 79%
In pooled randomized trials of lower-extremity surgery, adding a popliteal plexus block to another nerve block reduced nausea and vomiting by 79%, and also lowered opioid use over 24 hours and pain scores at 12 and 24 hours. The evidence applies only to add-on use; comparisons with other blocks remain limited and inconsistent.
- Journal
- The Korean journal of pain (Q1)
- Published
- 1 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Jiyoun Lee, Ji-Hyeon Lee, Young-Woong Choi, Hyo-Seok Na, Hyun-Jung Shin
- PMID
- 42816134
- DOI
- 10.3344/kjp.26265
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 2 October 2026): Meta-analysis, PPB reduces opioid use and PONV
- Picked for Epidemiology (paper of the day, 2 October 2026): Meta‑analysis of popliteal plexus block efficacy for opioid sparing
Abstract
BACKGROUND: Postoperative pain management often depends on opioids, despite the associated adverse effects. The popliteal plexus block (PPB) presents a promising technique to reduce opioid consumption in surgeries. METHODS: This meta-analysis evaluates the effectiveness of PPB when added to other nerve blocks, as well as its comparative efficacy against other block techniques, in improving postoperative recovery. Randomized controlled trials (RCTs) investigating the effect of PPB in adults undergoing lower extremity surgery were included. The primary outcome was 24-hour opioid consumption; secondary outcomes included pain scores at 12 and 24 hours, and the incidence of postoperative nausea and vomiting (PONV). The pooled effect size was quantified using mean difference (MD), standardized MD (SMD), or relative risk (RR) with a 95% confidence interval (CI). RESULTS: Quantitative synthesis was restricted to studies evaluating PPB as an add-on to another nerve block technique. Compared with the standalone comparator, PPB significantly reduced 24-hour opioid consumption (5 studies; SMD: -1.32; 95% CI: -2.29 to -0.34), pain scores at 12 hours (4 studies; MD: -1.32; 95% CI: -2.25 to -0.39) and 24 hours (4 studies; MD: -0.52; 95% CI: -1.02 to -0.02), and the incidence of PONV (3 studies; RR: 0.21; 95% CI: 0.08 to 0.55). Three additional single-trial head-to-head comparisons (vs. other blocks) were not pooled and are reported narratively. CONCLUSIONS: As an add-on, PPB reduces opioid consumption, pain scores, and PONV incidence. Head-to-head evidence against other blocks remains limited and inconsistent; further high-quality RCTs are warranted to clarify comparative efficacy and address heterogeneity.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.