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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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Updated: Jun 11, 2025

A Mouse Model of Orthopedic Surgery to Study Postoperative Cognitive Dysfunction and Tissue Regeneration
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The use of peripheral nerve block decrease incidence of postoperative cognitive dysfunction following orthopedic

Liyun Deng1,2, Bo Jiao1,2, Jingjing Cai1,2

  • 1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

BMC Anesthesiology
|October 2, 2024
PubMed
Summary

Peripheral nerve block (PNB) combined with general anesthesia (GA) reduces postoperative cognitive dysfunction (POCD) after orthopedic surgery. However, this anesthesia combination does not significantly alter the incidence of postoperative delirium (POD).

Keywords:
Combined anesthesiaOrthopedic surgeryPeripheral nerve blockPostoperative neurocognitive disorders

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Area of Science:

  • Anesthesiology
  • Neuroscience
  • Surgical Outcomes

Background:

  • Postoperative neurocognitive disorders (PNDs), encompassing postoperative cognitive dysfunction (POCD) and postoperative delirium (POD), are common after orthopedic surgery.
  • The impact of combining peripheral nerve block (PNB) with general anesthesia (GA) on PND incidence remains unclear.

Purpose of the Study:

  • To investigate the effect of PNB plus GA on the incidence of POCD and/or POD following orthopedic surgery compared to GA alone.

Main Methods:

  • A meta-analysis of twelve randomized controlled trials (RCTs) involving 1488 patients was conducted.
  • The primary outcome was the incidence of POD and POCD.
  • Data were analyzed using risk ratios (RR) for dichotomous outcomes.

Main Results:

  • PNB plus GA significantly decreased the incidence of POCD (RR: 0.58, 95%CI: 0.35 to 0.95) compared to GA alone.
  • There was no significant difference in the incidence of POD (RR: 0.87, 95%CI: 0.54 to 1.40).
  • The combined anesthesia also led to reduced intraoperative and postoperative opioid consumption and lower incidence of postoperative nausea and vomiting.

Conclusions:

  • Combining PNB with GA is effective in reducing the incidence of POCD after orthopedic surgery.
  • This anesthesia approach does not significantly impact POD rates but offers benefits in pain and nausea management.