• Narinder P Singh, MakkarJeetinder KaurJK0000-0001-8159-5920Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India jeet1516@gmail.com., Anuradha Borle, and Preet Mohinder Singh.
• Department of Anesthesiology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India.
• Reg Anesth Pain Med. 2024 Jan 11; 49 (1): 495849-58.

Background/ImportancePostoperative 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.ObjectiveThe 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 ReviewPubMed, 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.FindingsTwenty-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.ConclusionsCurrent evidence suggests that supplemental RAB are beneficial in preventing PNCD in patients after major non-cardiac surgery.Prospero Registration NumberCRD42022338820.© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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