Authors: Zhang H et al.
Anesthesiology, February 25, 2026, 10.1097/ALN.0000000000005921
This two-center retrospective cohort study examined whether peripheral nerve blocks (PNBs) are associated with reduced postoperative myocardial injury in older adults undergoing hip fracture surgery. Postoperative myocardial injury is common in elderly patients with hip fractures and is strongly associated with increased postoperative mortality. Acute postoperative pain has been identified as a potential contributor to myocardial injury through sympathetic activation, increased myocardial oxygen demand, and hemodynamic stress.
The investigators analyzed medical records from patients aged 65 years or older who underwent hip fracture surgery between 2012 and 2023 under either general anesthesia or neuraxial anesthesia. Patients were divided into two groups depending on whether they received a single-injection peripheral nerve block as an adjunct to their primary anesthetic technique.
The primary outcome was postoperative myocardial injury, defined as any cardiac troponin value exceeding the 99th percentile upper reference limit during the index hospitalization.
A total of 1,467 patients were included in the analysis. Of these, 798 patients received a peripheral nerve block and 669 patients did not. Because this was an observational study, the authors used inverse probability of treatment weighting based on 27 baseline and intraoperative variables to reduce confounding between groups. Missing data, present in about 24% of cases, were addressed using multiple imputation.
Postoperative myocardial injury occurred in 12.0% of patients who received a peripheral nerve block compared with 21.5% of those who did not receive a block. After statistical adjustment for confounding factors, peripheral nerve block use was associated with a significantly lower risk of myocardial injury. The adjusted odds ratio for myocardial injury with peripheral nerve block was 0.60, indicating approximately a 40% reduction in the odds of myocardial injury compared with patients who did not receive a block.
The authors suggest that improved analgesia may reduce physiologic stress responses following surgery. Severe pain can trigger sympathetic activation, tachycardia, and increased myocardial oxygen demand, which may contribute to myocardial ischemia in vulnerable elderly patients. By providing effective analgesia, peripheral nerve blocks may attenuate this stress response and reduce the likelihood of myocardial injury.
Despite these findings, the authors emphasize several limitations. As a retrospective observational study, the results cannot establish a causal relationship. Residual confounding may remain despite statistical adjustment. Additionally, the study had a relatively high proportion of missing data that required imputation, and unmeasured clinical factors may have influenced both block use and patient outcomes.
The authors conclude that peripheral nerve blocks may be associated with improved cardiac outcomes in high-risk elderly patients undergoing hip fracture surgery, but prospective randomized trials are needed to confirm these findings.
What You Should Know
Postoperative myocardial injury is common in elderly patients undergoing hip fracture surgery and is associated with increased mortality.
Acute postoperative pain may contribute to myocardial injury through sympathetic activation and increased cardiac workload.
In this study, peripheral nerve blocks were associated with significantly lower rates of postoperative myocardial injury.
Patients receiving nerve blocks had approximately a 40% lower adjusted odds of myocardial injury compared with those who did not receive blocks.
Although promising, these findings require confirmation in prospective randomized trials.
Key Points
Retrospective cohort study including 1,467 older adults undergoing hip fracture surgery.
Peripheral nerve blocks were used as an adjunct to general or neuraxial anesthesia.
Myocardial injury occurred in 12.0% of patients with a block versus 21.5% without a block.
Peripheral nerve block use was associated with a significantly lower adjusted risk of myocardial injury.
Improved analgesia and reduced physiologic stress may explain the association.
Further randomized trials are needed to determine whether peripheral nerve blocks directly reduce postoperative myocardial injury.
Thank you to Anesthesiology for allowing us to summarize this article.