New study highlights protective cardiovascular effects of regional anesthesia

A major new study published in Anesthesiology (2026) has revealed that peripheral nerve blocks (PNBs) may significantly reduce the risk of postoperative myocardial injury in older adults undergoing hip fracture surgery.

This finding is particularly important because myocardial injury after noncardiac surgery (MINS) is a common and life-threatening complication, especially in elderly patients with pre-existing cardiovascular disease.

The study analyzed 1,467 patients and provides strong evidence that optimizing perioperative analgesia may have cardioprotective effects beyond pain control.

Understanding myocardial injury after hip fracture surgery

What is myocardial injury?

Myocardial injury refers to damage to cardiac muscle cells, typically identified by elevated cardiac troponin (cTn) levels above the 99th percentile upper reference limit.

• Indicates myocardial cell necrosis
• May occur with or without classic ischemic symptoms
• Strongly associated with increased mortality

Why is it important?

• Occurs in 15–86% of hip fracture patients depending on population and monitoring
• Linked to:
  • Increased 30-day mortality
  • Higher 1-year mortality rates
  • Prolonged hospitalization

Hip fracture patients are especially vulnerable due to:

• Advanced age
• High prevalence of cardiovascular comorbidities
• Physiological stress from trauma and surgery

Study overview: design and patient population

Study design

• Two-center retrospective cohort study
• Conducted in Beijing, China
• Study period: 2012–2023

Participants

• 1,467 patients aged ≥ 65 years
• All underwent hip fracture surgery under:
  • General anesthesia
  • Neuraxial anesthesia

Grouping

Patients were divided into:

• PNB group (798 patients)
• Non-PNB group (669 patients)

Nerve block techniques used

• Fascia iliaca compartment block (~70%)
• Femoral nerve block
• Lumbar plexus block
• Less common:
  • Sciatic nerve block
  • Pericapsular nerve group block

Key findings: reduced risk of myocardial injury

Primary outcome results

• Myocardial injury incidence:
  • 12.0% with PNB
  • 21.5% without PNB

This represents a substantial reduction.

Statistical analysis

• Adjusted odds ratio (OR): 0.60
• 95% confidence interval: 0.44–0.82
• P = 0.002 (statistically significant)

Interpretation

Patients receiving PNB had:

• 40% lower odds of postoperative myocardial injury

Why do peripheral nerve blocks help?

Physiological mechanisms

PNB likely reduces myocardial injury through several pathways:

• Pain reduction
  • Decreases sympathetic nervous system activation
• Hemodynamic stability
  • Reduces tachycardia and hypertension
• Lower myocardial oxygen demand
• Reduced stress hormone release

Pain–heart connection

Acute postoperative pain has been directly linked to:

• Increased catecholamine release
• Elevated cardiac workload
• Higher risk of ischemic injury

Additional benefits observed

Improved postoperative outcomes

Patients receiving PNB also demonstrated:

• Earlier hospital discharge
• Shorter ICU stays
• Reduced ICU admission rates
• Lower need for blood transfusion

Secondary outcomes

• ICU admission reduced (OR 0.39)
• Transfusion risk reduced (OR 0.33)
• Faster recovery trajectory

Clinical implications

Shift in perioperative care

This study suggests that:

• Focus should expand beyond anesthesia type
• Greater emphasis on multimodal analgesia strategies

Guideline relevance

Current guidelines already recommend PNB for:

• Pain control in hip fractures

This study adds:

• Potential cardioprotective indication

Expert perspective

The findings reinforce a growing concept in perioperative medicine:

Effective pain control is not just about comfort, it directly impacts organ function and survival.

By reducing physiological stress, PNB may act as a systemic protective intervention, particularly in frail, high-risk populations.

Conclusion

Peripheral nerve blocks represent a promising strategy to reduce postoperative myocardial injury in older adults undergoing hip fracture surgery.

Reference: Zhang H et al. Association of Peripheral Nerve Block with Postoperative Myocardial Injury in High-risk Cardiac Older Adults Undergoing Hip Fracture Surgery: A Two-center Retrospective Cohort Study. Anesthesiology. 2026;144:1094-1104. 

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