# Vagus nerve stimulation: a potential tool to further improve perioperative anesthesia management quality and postoperative recovery?

## TL;DR

Vagus nerve stimulation (VNS) may improve anesthesia and recovery by reducing inflammation and opioid use during surgery.

## Contribution

This review explores new applications of VNS in perioperative care and summarizes its mechanisms for personalized management.

## Key findings

- VNS reduces surgical inflammation via α7nAChR-mediated pathways.
- VNS may lower opioid use and improve postoperative recovery.
- Applications span preoperative anxiety, intraoperative anesthesia, and postoperative pain.

## Abstract

Vagus nerve stimulation (VNS) is a promising neuromodulation technique that exerts organ-protective effects through the activation of cholinergic anti-inflammatory pathways and the modulation of the autonomic nervous system. In recent years, its potential applications in perioperative medicine have garnered increasing research attention. A limited body of clinical evidence indicates that VNS can alleviate the inflammatory response induced by surgical stress by inhibiting the α7 nicotinic acetylcholine receptor (α7nAChR)-mediated NF-κB signaling pathway. It may reduce the demand for opioids in perioperative pain management, potentially accelerate patients’ postoperative recovery, and show promise for improving outcomes in cardiac, abdominal, and neurosurgical procedures. Herein, this article explores the potential further application directions of VNS in the perioperative period and summarizes the possible mechanisms based on previous studies, including preoperative anxiety management, intraoperative adjuvant anesthesia, postoperative pain management, and complication prevention. In summary, this review explores the potential of VNS to contribute to personalized perioperative management, while acknowledging that its widespread clinical integration necessitates further rigorous investigation.

Applications and stimulation methods of vagus nerve stimulation (VNS) in perioperative care: from preoperative preparation to postoperative recovery.Infographic presents vagus nerve stimulation (VNS) applications and methods across preoperative, intraoperative, and postoperative stages. Preoperative focuses on emotion and sleep management, immune preadaptation, and uses non-invasive auricular VNS and closed-loop systems. Intraoperative addresses anesthesia adjunct, organ protection, hemodynamic stability, with transcutaneous cervical VNS and real-time adaptive systems. Postoperative covers pain management, gastrointestinal recovery, cognitive improvement, using taVNS and wearable closed-loop devices. Technical support, stimulation technologies, and mechanisms, such as anti-inflammatory pathways and neurotransmitter regulation, form the foundation. Icons represent each function or method for visual clarity.

Applications and stimulation methods of vagus nerve stimulation (VNS) in perioperative care: from preoperative preparation to postoperative recovery.