Authors: Zhang H et al.
Journal: Anesthesiology. December 29, 2025.
Summary
This two-center retrospective cohort study evaluated whether adding a single-injection peripheral nerve block (PNB) to general or neuraxial anesthesia is associated with a lower risk of postoperative myocardial injury in older adults with high cardiac risk undergoing hip fracture surgery. The investigators included 1,467 patients aged 65 years or older treated between 2012 and 2023. Patients were categorized based on whether they received a single-shot PNB in addition to their primary anesthetic technique.
The primary outcome was postoperative myocardial injury, defined as any postoperative cardiac troponin value exceeding the 99th percentile upper reference limit during the same hospitalization. To address confounding, the authors used inverse probability of treatment weighting based on 27 baseline and intraoperative variables, followed by weighted logistic regression. Missing data, which accounted for nearly one-quarter of cases, were handled with multiple imputation.
Postoperative myocardial injury occurred in 12.0% of patients who received a PNB compared with 21.5% of those who did not. After adjustment, use of a single-injection PNB was associated with significantly lower odds of myocardial injury (adjusted odds ratio 0.60, 95% CI 0.44–0.82). The authors suggest that improved analgesia and attenuation of the stress and sympathetic response to pain may explain this association, while emphasizing that causality cannot be established given the retrospective design.
Key Points
• Postoperative myocardial injury is common after hip fracture surgery in older, high-risk cardiac patients.
• Single-injection peripheral nerve blocks were associated with a meaningful reduction in postoperative troponin elevation.
• The observed benefit persisted after extensive adjustment for baseline and intraoperative confounders.
• Improved pain control and reduced physiologic stress may be the key mechanism.
What You Should Know
This study supports the growing concept that high-quality regional analgesia may offer cardioprotective benefits in frail orthopedic patients, beyond pain relief alone. While the findings are compelling, they should be viewed as hypothesis-generating; prospective randomized trials are still needed before PNBs can be recommended specifically to reduce myocardial injury risk.
References
None beyond the primary article.
Thank you to Anesthesiology for allowing the use and discussion of this important accepted manuscript.