Postoperative cognitive dysfunction (POCD) can greatly increase the possibility of patients developing dementia after surgery, affect the prognosis of patients, and increase medical care costs and family burdens. Basic research has shown that acupuncture can exert a certain brain protection effect and reduce the incidence of POCD through multiple mechanisms. This review summarized the research progress of acupuncture in the field of POCD in recent years and described several possible related mechanisms: inhibiting neuroinflammation, inhibiting oxidative stress levels, reducing neuronal damage, enhanced prominence plasticity and regulation of microbial flora brain-gut axis. The application of acupuncture to prevent POCD has indeed achieved certain results, but its mechanism of action is still not completely clear. With the continuous deepening of acupuncture research, it is necessary to clarify its mechanism of action as soon as possible for better guiding the clinical treatment of POCD.