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Role of supplemental regional blocks on postoperative neurocognitive dysfunction after major non-cardiac surgeries: a systematic review and meta-analysis of randomized controlled trials
  1. Narinder P Singh1,
  2. Jeetinder Kaur Makkar2,
  3. Anuradha Borle3 and
  4. Preet Mohinder Singh3
  1. 1Department of Anesthesiology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
  2. 2Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  3. 3Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  1. Correspondence to Dr Jeetinder Kaur Makkar, Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh160012, India; jeet1516{at}


Background/importance Postoperative neurocognitive dysfunction (PNCD) is a frequent and preventable complication after surgery. The large high-quality evidence for the efficacy of supplemental regional analgesia blocks (RAB) for preventing PNCD is still elusive.

Objective The objective of this meta-analysis was to evaluate the effect of RAB versus standard anesthesia care on the incidence of PNCD in adult patients undergoing major non-cardiac surgery.

Evidence review PubMed, EMBASE, Scopus, and the Cochrane Central Registers of Controlled Trials (CENTRAL) were searched for randomized controlled trials (RCTs) from 2017 until June 2022. The primary outcome was the incidence of PNCD within 1 month of surgery. A random-effects model with an inverse variance method was used to pool results, and OR and mean differences were calculated for dichotomous and continuous outcomes. Various exploratory subgroup analyses were performed to explore the possibility of the association between the various patient, technique, and surgery-related factors. Grading of Recommendation, Assessment, Development, and Evaluation guidelines were used to determine the certainty of evidence.

Findings Twenty-six RCTs comprizing 4414 patients were included. The RAB group was associated with a significant reduction in the incidence of PNCD with an OR of 0.46 (95% CI 0.35 to 0.59; p<0.00001; I2=28%) compared with the control group (moderate certainty). Subgroup analysis exhibited that the prophylactic efficacy of RAB persisted for both delirium and delayed neurocognitive recovery.

Conclusions Current evidence suggests that supplemental RAB are beneficial in preventing PNCD in patients after major non-cardiac surgery.

PROSPERO registration number CRD42022338820

  • Pain, Postoperative
  • analgesia
  • Outcome Assessment, Health Care
  • Treatment Outcome

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  • Contributors All the authors have participated sufficiently in the work to merit authorship and publicly defend the manuscript contents.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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