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Postoperative Cognitive Dysfunction and Analgesic Outcomes in Cardiac Surgery: Evaluating the Role of Nerve Block Techniques.

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Title: Postoperative Cognitive Dysfunction and Analgesic Outcomes in Cardiac Surgery: Evaluating the Role of Nerve Block Techniques.
Authors: Yan M; Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Beijing, China., Wang K, Yan H, Yuan S
Source: The Clinical journal of pain [Clin J Pain] 2026 Aug 01; Vol. 42 (8). Date of Electronic Publication: 2026 Aug 01.
Publication Type: Journal Article; Review
Language: English
Journal Info: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8507389 Publication Model: Electronic Cited Medium: Internet ISSN: 1536-5409 (Electronic) Linking ISSN: 07498047 NLM ISO Abbreviation: Clin J Pain Subsets: MEDLINE
Imprint Name(s): Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: [New York, N.Y.] : Raven Press, [c1985-
MeSH Terms: Cardiac Surgical Procedures*/adverse effects , Nerve Block*/methods , Postoperative Pain*/drug therapy , Postoperative Cognitive Complications*/prevention & control, Humans
Abstract: Objective: Cardiac surgery frequently induces moderate to severe postoperative pain that impedes recovery and elevates the risk of opioid dependence and postoperative cognitive dysfunction. This review aims to outline peripheral nerve block approaches in cardiac surgery and examine their analgesic efficacy and potential relationship with postoperative cognitive dysfunction.
Materials and Methods: A comprehensive literature search was performed using the electronic databases PubMed, EMBASE, and Google Scholar for publications up to September 2025. Search terms included regional anesthesia, nerve block, pain management, delirium, cognitive dysfunction, and cardiac surgery. The retrieved literature, including clinical reviews, basic research, clinical trials, and guidelines, was screened and prioritized based on thematic relevance and the strength of clinical evidence. The available evidence was synthesized into a narrative review.
Results: The evidence suggests that nerve blocks are an effective component of a multimodal analgesic strategy, significantly reducing postoperative opioid consumption and attenuating neuroinflammatory responses such as microglial activation. However, they have not been conclusively shown to reduce the incidence of postoperative cognitive dysfunction. Current implementation faces challenges, including a lack of technique standardization and the need to adapt to heterogeneous surgical anatomies.
Discussion: Nerve blocks are valuable for opioid-sparing analgesia and may modulate neuroinflammation, but their role in preventing postoperative cognitive dysfunction remains unproven. Future efforts should focus on standardizing protocols and conducting mechanistic studies to clarify the relationship between nerve blocks, neuroinflammatory modulation, and long-term neurological outcomes.
(Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc.)
Competing Interests: This work was supported by the National High-Level Hospital Clinical Research Funding (grant number 2022-GSP-GG-36) and the CAMS Innovation Fund for Medical Sciences (grant number 2023-I2M-1-004). The authors declare no conflict of interest. National High-Level Hospital Clinical Research Funding: National Health Commission of the People's Republic of China, Beijing, China. CAMS Innovation Fund for Medical Sciences: Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Grant Information: 2022-GSP-GG-36 the National High-Level Hospital Clinical Research Funding; 2023-I2M-1-004 the CAMS Innovation Fund for Medical Sciences (CIFMS)
Contributed Indexing: Keywords: analgesia; cardiac surgery; nerve block; postoperative cognitive dysfunction; regional anesthesia
Entry Date(s): Date Created: 20260403 Date Completed: 20260714 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13348836
DOI: 10.1097/AJP.0000000000001388
PMID: 41928696
Database: MEDLINE
Description
ISSN:1536-5409
DOI:10.1097/AJP.0000000000001388