Abstract: Objective To explore the effect of intercostal nerve blockade with ropivacaine followed by patient-controlled analgesia(PCA) infusion pump on postoperative pain and cognitive function in elderly patients with esophageal carcinoma. Methods Ninety-two elderly patients clinical diagnosed with esophageal carcinoma in our hospital were selected as the clinical research subjects,and the patients were numbered according to treatment order,and divided into two groups according to odd and even number.The 46 cases in the control group(odd) were treated with postoperative intravenous analgesia pump,and the other 46 cases in the observation group(even) received intercostal nerve blockade with ropivacaine followed by analgesia infusion pump.Intelligence examination scores (MMSE),pain score (VAS),comfort score (BCS) and incidence of cognitive impairment (POCD) were compared between the two groups. Results The MMSE score(24.79±2.66) and POCD incidence(8.70%) in the observation group was significantly better than those in the control group[MMSE score(20.87±2.43) and POCD incidence(26.09%)],and the differences were statistically significant(P<0.05).The VAS at rest(0.44±0.08),VAS at movement(1.42±0.36),and BCS(3.76±1.95) in one hour after awakening,the VAS at rest(2.23±1.92),VAS at movement(3.79±2.66),and BCS(2.55±1.43)% in 24h after awakening in the observation group recovered significantly better than the control group[VAS at rest(1.78±1.28),VAS at movement(3.47±1.23),and BCS(2.56±1.88) points in one hour after awakening,the VAS at rest(4.18±1.88),VAS at movement(6.87±2.43),and BCS(1.83±1.12) points in 24 h after awakening],and the differences were statistically significant(P<0.05). Conclusion Postoperative intercostal nerve blockade with ropivacaine followed by patient-controlled analgesia infusion pump for elderly patients with esophageal carcinoma can effectively reduce postoperative pain,significantly improve postoperative cognitive function,and improve the overall life quality of patients.