There is limited research data on the effect of different ventilation modes and airway devices on postoperative pulmonary complications (PPCs) during esophagectomy. Our single-center retrospective study aimed to compare the incidence of PPCs between two-lung ventilation (TLV) with CO₂ artificial pneumothorax using a single-lumen tube (SLT) and one-lung ventilation (OLV) using either a double-lumen tube (DLT) or a bronchial blocker (BB). Patients undergoing either open or minimally invasive surgeries on esophageal cancer between January 1st, 2022, and December 31st, 2024, at a tertiary teaching hospital were enrolled in the study. All the eligible cases were grouped based on the ventilation modes: TLV with CO2 artificial pneumothorax using an SLT and OLV with a DLT or a BB. The primary outcome was PPCs, which were defined with clinical manifestations and imaging findings, including pneumonia, hemothorax, hydrothorax, pulmonary atelectasis, acute respiratory distress syndrome (ARDS), and respiratory failure requiring mechanical ventilation. The secondary outcomes included pneumonia, in-hospital mortality, hospital length of stay (LOS), reoperation, anastomotic leak, infection, deep venous thrombus (DVT), chylothorax, and overall postoperative complications. A total of 455 patients were included, with 331 patients in the TLV cohort and 124 patients in the OLV cohort. According to the unadjusted and adjusted analyses, patients in the TLV cohort had a lower incidence of PPCs (31/331 vs. 20/124, 9.4

PURPOSE:This study aimed to evaluate the effects of remimazolam in conjunction with esketamine on anesthesia and the incidence of early perioperative neurocognitive disorders (PNDs) in patients undergoing thoracoscopic partial lung resection. METHODS:Eighty patients scheduled for thoracoscopic lobectomy were randomly assigned 1:1 to either the remimazolam group (group R) or the propofol group (group P). Group R received remimazolam for induction and maintenance of anesthesia, whereas group P received propofol. Both groups received intravenous esketamine before skin incision. The following parameters were compared: mean arterial pressure, heart rate, and perfusion index; extubation time, postanesthesia care unit stay duration, length of stay; arterial blood gas potassium, sodium, and glucose levels; hepatic and renal function markers; incidence of early PNDs and postoperative delirium (POD); safety indicators including visual analog scale scores, injection pain, Richmond Agitation-Sedation Scale sedation scores, and postoperative nausea and vomiting. FINDINGS:The incidence of POD and early PNDs did not differ significantly between the 2 groups (P > 0.05). Mean arterial pressure in group R was significantly higher than in group P (P < 0.05). Heart rate in group R was higher than in group P at 1 minute after tracheal intubation (P < 0.05). Perfusion index values did not differ significantly between groups (P > 0.05). Extubation time, postanesthesia care unit stay time, and length of stay were shorter in group R than in group P (P < 0.05), whereas sedation depth was greater in group R (P < 0.05). Within group R, blood glucose decreased at 1 minute after intubation and increased at 10 minutes after extubation (P < 0.05). Although total bilirubin showed significant postoperative elevation in both groups (P < 0.05), all other hepatic/renal function parameters remained comparable (P > 0.05). Visual analog scale scores showed no significant intergroup differences (P > 0.05). The incidence of injection pain and postoperative nausea and vomiting was lower in group R than in group P (P < 0.05). IMPLICATIONS:Compared with propofol combined with esketamine, general anesthesia using remimazolam combined with esketamine provides more stable hemodynamics without increasing adverse reactions, has less impact on patient electrolytes and liver/kidney function, and does not increase the incidence of early PNDs or POD; furthermore, it can decrease the hospitalization period as well as the economic pressure on patients. This may offer a novel approach to anesthesia induction and maintenance for clinically elderly patients and those with impaired hepatic or renal function. Chinese Clinical Trial Registry identifier: ChiCTR2500104188; registration date: June 12, 2025; retrospective registration; Website: https://www.chictr.org.cn).

Inhibition of ferroptosis was shown to alleviate pulmonary ischemia/reperfusion (I/R) injury. This study aimed to investigate the synergistic effects of bone marrow mesenchymal stem cells (BMSC)-derived exosomal METTL3 and Sevoflurane (Sev) in alleviating pulmonary I/R injury through ferroptosis regulation. In our study, pulmonary I/R injury models were established in mice and lung microvascular endothelial cells (LMECs). Commercial kits were used to measure myeloperoxidase (MPO), glutathione (GSH), malondialdehyde (MDA), and iron content. Lipid peroxidation was determined using the BODIPY 581/591 C11 probe by flow cytometry. Total m6A modification was measured by the commercial kit and m6A dot blot, while m6A modification of USP7 mRNA was analyzed by MeRIP and polysome profiling. The interaction between proteins or RNAs was analyzed by Co-IP, FISH combined with immunofluorescence, RNA pull-down, RIP, or dual-luciferase reporter assay. We proved Sev preconditioning mitigated ferroptosis in pulmonary I/R injury by activating the Nrf2 pathway. Co-treatment with BMSC-derived exosomes potentiated the protective effects of Sev by promoting USP7-mediated Nrf2 deubiquitination modification. Mechanistically, BMSC-derived exosomal METTL3 promoted USP7 mRNA translation through YTHDC2-dependent m6A modification. Also, METTL3 knockdown in exosomes suppressed the Nrf2 pathway and exacerbated ferroptosis, while METTL3 overexpression showed opposite effects. YTHDC2 knockdown abolished these protective effects caused by METTL3-overexpressed exosomes. In conclusion, BMSC-derived exosomal METTL3 reinforced the protective effects of Sev by promoting USP7 mRNA translation via YTHDC2-dependent m6A modification. Upregulated USP7 subsequently facilitated Nrf2 deubiquitination, thereby inhibiting ferroptosis and protecting against pulmonary I/R injury.

BACKGROUND:Rhomboid intercostal and sub-serratus plane (RISS) block is a novel nerve block technique that provides good analgesia, but overall research is scarce. This study aimed to investigate the effect of ultrasound-guided RISS block on postoperative analgesia and diaphragmatic excursion (DE) after video-assisted thoracic surgery (VATS) for lung cancer. METHODS:One hundred patients who underwent VATS lung resection participated in this study and were randomized to a RISS group (Group R) or a control group (Group C). Group R underwent ultrasound-guided RISS block with 0.25% ropivacaine hydrochloride 0.5 ml/kg immediately after surgery. Group C was given standard general anaesthesia, and patient-controlled intravenous analgesia (PCIA) was used in the postoperative period in both groups. The visual analogue scores (VAS) at rest and during movement at 2 hours(h), 24 h, and 48 h postoperatively were used as the primary outcome measures. Secondary outcomes included postoperative consumption of sufentanil; preoperative and postoperative left and right-sided DE during calm and deep breathing, and the occurrence of adverse effects such as postoperative nausea and vomiting (PONV), dizziness, somnolence, puncture site infection, and hematoma. RESULTS:At 2 h, 24 h, and 48 h postoperatively, patients in Group R had lower VAS scores at rest (median [Q1, Q3]: 1.00 [1.00, 1.00]; 1.00 [1.00, 1.00]; 0.00 [0.00, 1.00]) and during movement (2.00 [2.00, 3.00]; 2.00 [2.00, 2.00]; 2.00 [1.00, 2.00]) than those in Group C (resting: 2.00 [2.00, 2.00]; 2.00 [2.00, 2.00]; 1.00 [1.00, 2.00]; movement: 3.00 [3.00, 4.00]; 3.00 [3.00, 4.00]; 3.00 [2.00, 4.00]) (all P < 0.0001). Sufentanil consumption at 2 h, 24 h, and 48 h postoperatively was also significantly lower in Group R (P = 0.0002, P < 0.0001, P < 0.0001). Preoperatively, no significant difference in DE existed between the groups (P > 0.05). At 30 min post-extubation and 2 h and 24 h postoperatively, during both calm and deep breathing on both sides, Group R had significantly greater DE than Group C (P < 0.05). At 48 h postoperatively, the right-sided DE during calm breathing showed no significant difference between the groups. PONV incidences did not differ significantly (P = 0.2662), and Group R had less dizziness, somnolence, higher satisfaction post-surgery, and showed no cases of puncture site infection or hematoma. CONCLUSIONS:Ultrasound-guided RISS block can modestly reduce postoperative pain in patients undergoing VATS, with clinically relevant benefits, and may help alleviate diaphragmatic dysfunction caused by surgical or anesthetic factors. TRIAL REGISTRATION:The trial was registered at the China Clinical Trial Registry ( http://www.chictr.org.cn , ChiCTR2300070842) on 24/04/2023.

Purpose Investigate the analgesia effects and pharmacokinetics of ropivacaine at different concentrations in Serratus Anterior Plane Block (SAPB) and assess the efficacy and safety. Methods Thirty-six patients undergoing video-assisted thoracoscopic surgery (VATS) pulmonary resections were enrolled. Ultrasound-guided SAPB was induced with 3 mg/kg ropivacaine at different concentrations (0.25%, 0.5%, and 0.75%, referred to as Group L, Group M, and Group H, respectively). The concentration of ropivacaine in the plasma at 1, 15, 30, 45, 60 min, 2, 4, 8, 12, and 24 h after SAPB was determined by LC-MS/MS. Other evaluated measures included the Numerical Rating Scale (NRS) scores at rest and on movement, the frequency of dermatomes blocked, onset time and effective plane, Quality of Requirements(QoR)-15 scale, chronic postsurgical pain, and the level of IL-6 and IL-8. Findings The NRS scores were significantly higher in Group L than those in other groups (P < 0.05), indicating that the analgesic effect of Group L was the worst among the three groups. Group H had a lower effective plane of anesthesia and significantly higher incidence of chronic postsurgical pain. The IL-8 level was significantly lower in Group H than in other groups at 1 min, 1 h, and 24 h after SAPB. The ropivacaine concentrations were the highest in Group H, followed by Group M and Group L. The high blood concentration of ropivacaine in Group H may increase the risk of systemic toxicity from local anesthetics. Compared to Group L and Group H, Group M had superior analgesic effects and better safety. Among the three groups, Cmax, t1/2, and AUC0-∞ differed significantly. Implications For patients undergoing VATS, using 0.5% ropivacaine for SAPB is recommended.

Postoperative Nausea and Vomiting (PONV) is a potential complication in all people undergoing general anesthesia (GA), causing significant discomfort and potentially leading to serious complications. Despite decades of research and the implementation of various preventive drugs and measures, complete prevention via traditional guidelines continues to pose challenges in clinical settings. This article will review mechanisms, influencing factors (including patient-related, surgery-related, and anesthesia-related factors), and strategies for prevention and treatment, both pharmacological and non-pharmacological, for PONV in adultsunder GA. This manuscript also summarizes randomized trials investigating the incidence of PONV in adults receiving opioid-sparing or opioid-free perioperative GA-based protocols. This review aims to summarize evidence-based guidance amidst traditional guidance, and other recent considerations, for optimizing anesthetic management strategies in clinical practice.

Aim Our study aimed to investigate whether BMSCs-derived exosomal miR-381 promotes Treg cell differentiation in lung ischemia-reperfusion injury (LIRI), and the underlying mechanism. Methods The in vitro and in vivo models of LIRI were established by hypoxia/reoxygenation (H/R) treatment and lung ischemia/reperfusion (I/R) surgery, respectively. BMSCs-derived exosomes were isolated and identified by western blot, nanoparticle tracking analysis, and transmission electron microscopy. Cell viability, proliferation, and apoptosis were assessed by CCK-8, EdU, and flow cytometry assay, respectively. IL-18 secretion level in lung microvascular endothelial cells (LMECs) and lung tissue homogenate was examined by ELISA. Treg cell differentiation was determined using flow cytometry. The relationships between miR-381, YTHDF1, and IL-18 were investigated using dual-luciferase reporter gene, RIP, and/or RNA pull-down assays. MeRIP assay was employed to determine m6A modification of IL-18 mRNA in LMECs. The ubiquitination level of Foxp3 protein in CD4+ T cells was analyzed by Co-IP assay. Results BMSCs-derived exosomes reduced LMECs injury and increased Treg cell differentiation in LIRI, whereas miR-381 inhibition in BMSCs weakened these impacts. Mechanistically, miR-381 inhibited IL-18 translation in LMECs by inhibiting YTHDF1 expression via binding to its 3’-UTR. As expected, YTHDF1 overexpression in LMECs abolished the effects of miR-381-overexpressed exosomes on LMECs injury and Treg cell differentiation. Moreover, LMECs-secreted IL-18 inhibited Treg cell differentiation by promoting the ubiquitination degradation of Foxp3 protein. Conclusion BMSCs-derived exosomal miR-381 suppressed IL-18 translation in LMECs through binding to YTHDF1 3’-UTR, thus suppressing the ubiquitination degradation of Foxp3 in CD4+ T cells, which promoted Treg cell differentiation and mitigated LIRI development.

Objective: To study the effect of dexmedetomidine (Dex) on perioperative inflammatory response in aortic dissection (AD) patients. Methods: From June 2020 to June 2022, 50 patients with Stanford type B AD underwent endovascular stent-graft exclusion (EVAR) at our hospital. They randomly were assigned to two groups (N = 25): the control group (C group) and the Dex group. Patients in the Dex group received 0.5ug/kg Dex intravenously 10 minutes before induction of anesthesia and 0.5µg/kg/h Dex during the intervention until 15 minutes before the end of surgery. In contrast, the C group received the same volume of normal saline at the same time points. The two groups were induced and maintained with the same anesthetic agents. Venous blood samples were taken 3 days before operation (T1), 1 day before operation (T2), 1 day after operation (T3) and 3 days after operation (T4) to detect levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell count (WBC). Results: At T3 and T4, CRP and ESR in the Dex group were significantly improved compared with those in the C group. Conclusion: Dexmedetomidine can reduce the inflammatory reaction of aortic dissection.

BACKGROUND This meta-analysis aimed to compare the potential effects of local anesthesia (LA) and general anesthesia (GA) for transcatheter aortic valve implantation (TAVI). MEASUREMENTS All relevant studies were searched from Pubmed, EMbase, Web of Science, and the Cochrane Library (January 1, 2016, to June 1, 2021). The main outcomes of this literature meta-analysis were 30-day mortality, procedural time, new pacemaker implantation, total stay in the hospital, use of the vasoactive drug, and intra-and postoperative complications and emergencies, including conversion to open, myocardial infarction, pulmonary complication, vascular complication, renal injury/failure, stroke, transesophageal echocardiography, life-threatening/major bleeding, cardiac tamponade, and emergency PCI. Pooled risk ratio (RR) and mean difference (MD) together with a 95% confidence interval (CI) were calculated. RESULTS A total of 17 studies, including 20938 patients, in the final analysis, fulfilled the inclusion criteria. Intra-and postoperative complications (myocardial infarction, vascular complication, renal injury/failure, stroke, and cardiac tamponade) undergoing TAVI in severe AS patients under GA do not offer a significant difference compared with LA. No differences were observed between LA and GA for new pacemaker implantation, total stay in the hospital, transesophageal echocardiography, and emergency PCI. LA has lower mortality compared with GA (RR 0.69, P = 0.600), pulmonary complications (RR 0.54, P = 0.278), life-threatening/major bleeding (RR 0.85, P = 0.855), and lower times of conversion to open (RR 0.22, P = 0.746). LA has many advantages, including a shorter procedure duration (MD=-0.38, P = 0.000) and reduction of the use of the vasoactive drug (RR 0.57, P = 0.000). CONCLUSIONS For TAVI, both LA with or without sedation and GA are feasible and safe. LA appears a feasible alternative to GA for AS patients undergoing TAVI.

Abstract The effectiveness of anterior serratus plane block in postoperative analgesia of thoracic surgery is beginning to emerge. Currently, there are 2 methods of anterior serratus plane block: deep serratus plane block (DSPB) and superficial serratus plane block (SSPB). In clinical practice, there is no an unified view regarding the advantages and disadvantages between 2 methods. This study aimed to observe and compare the analgesic effects of 2 methods on patients undergoing thoracoscopic lobectomy, in order to provide some suggestions for anesthesiologists when they choose anterior serratus plane block to perform postoperative analgesia for patients. Patients were randomly divided into 3 groups (21 patients/group):1. general anesthesia group (P group);2. combined general anesthesia and SSPB group (S group), and3. combined general anesthesia and DSPB group (D group). The patients in groups S and D received 0.4 ml/kg of 0.375% ropivacaine for ultrasound-guided block after surgery. Postoperatively, flurbiprofen was used for rescue analgesia. Visual analog scale (VAS) pain scores were recorded at 6 hours, 12 hours, and 24 hours after surgery, and rescue analgesia, post-operative nausea, and vomiting were reported within 24 hours after surgery. At 6 hours, 12 hours, and 24 hours, the VAS scores and the rescue analgesia rates in groups S and D were significantly lower than those in group P (all P < .001). With prolonging time, the VAS in group D was significantly increased by 0.11 per hour as compared with that of group P (P < .0001); VAS in group D was significantly increased by 0.12 per hour as compared with that of group S (P < .0001). Ultrasound-guided anterior serratus plane block can provide adequate analgesia for patients undergoing thoracoscopy lobectomy. SSPB can significantly improve VAS scores as compared to DSPB at 24 hours.

This study aimed at exploring the effects of combined epidural anesthesia and general anesthesia on the cognitive function and stress responses of elderly patients undergoing liver cancer surgery. One hundred and fifteen elderly patients were enrolled as research subjects. They were admitted to our hospital and underwent liver cancer surgery from August 2017 to May 2019. Fifty five cases were treated with general anesthesia (GA) (GA group), while the other sixty cases were treated with combined epidural anesthesia and general anesthesia (joint group). Scoring standards of Mini-Mental State Examination (MMSE) were used to evaluate the patients before and after operation. Their operating time, total fluid input (TFI), spontaneous breathing recovery time (SBRT), preoperative and postoperative indices of stress responses (epinephrine (EPI), cortisol (Cor), and norepinephrine (NE)), and postoperative adverse reactions were observed. There were statistically significant differences between the two groups with respect to anesthesia time, TFI, postoperative SBRT, and postoperative directional recovery time (DRT) (cP<0.05). There was no difference in operating time, total fluid loss (TFL), and hospitalization time (P>0.05). After operation, patients in both groups experienced a cognitive decline of different degrees and the MMSE scores decreased. There was no significant difference in the score between the two groups before operation and 3 days and 7 days after operation (P>0.05). The score was significantly better in the joint group than that in the GA group at 6 hours and 1 day after operation (P<0.05). There were no significant differences in levels of EPI, Cor, and NE between the two groups before operation (P>0.05), but there were significant differences after operation. The total incidence of postoperative adverse reactions was 11.67% in the joint group and 25.45% in the GA group. In conclusion, combined epidural anesthesia and general anesthesia can significantly reduce postoperative cognitive dysfunction and inhibit postoperative stress responses in elderly patients undergoing liver cancer surgery. It has good application value in clinical practice.

Background: Total Hip Arthroplasty(THA) is a surgical treatment for hip disease. A large amount of evidence has been reported on comparing outcomes of neuraxial(spinal or epidural) anesthesia and general anesthesia. However, it is unclear whether nerve blocks(NB) as main anesthesia technique compared with general anesthesia(GA) for THA could reduce perioperative complications. We conducted a retrospective evaluation of NB and GA, using a propensity score-matched analysis(PSMA). Methods: A total of 902 patients older than 60 years old with hip disease undergoing primary THA received combined lumbosacral plexus and T12 paravertebral nerve blocks (n = 143) or GA (n = 759) at our institution from 2012 to 2018.Binary logistic regression was used for comparison of the primary outcomes(the incidence of delirium) and the secondary outcomes(the percentage of postoperative hemoglobin(>10g/dl), transfusion(>2 units), major cardiac events(MACE), postoperative pulmonary complications (PPC) and 30-day mortality) in the matched cohorts.Statistical analysis was performed using SPSS v 23.0. Results: Both cohorts were balanced in all included parameters after PSMA. The incidence of delirium was lower (OR 0.233,95% CI 0.064-0.845, p = 0.030) in NB group in matched cohorts. In the unmatched and matched cohorts, the percentage of Hb(>10g/dl) was higher in GA group but the incidence of transfusion(>2 units) was higher in NB group. No difference was found in the incidence of 30-day mortality in the unmatched and matched cohorts. In the unmatched cohorts, the incidence of PPC was higher and LOS was longer in NB cohort, but no difference was observed in the matched cohorts. Conclusion: In patients older than 60 years old receiving primary THA, NB could be associated with a lower incidence of delirium.

Malignant glioma is the most common primary malignancy in the brain. It is aggressive, highly invasive, and destructive. Studies have shown that sevoflurane can affect the invasion and migration of a variety of malignant tumors. However, its effects on human glioma cells and related mechanisms are not clear. Cultured U251 and U87 cells were pretreated with sevoflurane. The effect of sevoflurane on cell proliferation, migration, apoptosis and invasion ability were evaluated by MTT, wound healing assay, cell apoptosis and transwell assays, respectively. miRNA-124-3p and ROCK1 signaling pathway genes expression in sevoflurane treated cell lines was measured by quantitative real-time PCR (qRT-PCR) and western blotting analysis. The potential target genes of miRNA were predicted by online software. Luciferase reporter assay was employed to validate the direct targeting of ROCK1 by miRNA-124-3p. In present studies, sevoflurane inhibits glioma cells proliferation, invasion and migration. Additionally, inversely correlation between miR-124-3p and ROCK1 expression in sevoflurane treated glioma cells was observed. Furthermore, sevoflurane inhibits glioma cells proliferation, migration and invasion through miR-124-3p/ROCK1 axis. Taken together, our study revealed that sevoflurane can inhibit glioma cell proliferation, invasion and migration. Its mechanism may be related to the upregulation of miR-124-3p, which suppresses ROCK1 signaling pathway. The results of the study will help to understand the pharmacological effects of inhaled general anesthetics more comprehensively and help to provide an experimental basis for selecting more reasonable anesthetics for cancer patients.

Sevoflurane is a new type of inhalation anesthetic used widely in the clinic. It has the characteristics of rapid induction, rapid recovery, and less irritative to the airway. Studies have shown that sevoflurane can affect the invasion and migration of a variety of malignant tumors. However, its effects on human glioma cells and related mechanisms are not clear. Cultured U251 and U87 cells were pretreated with sevoflurane. The effect of sevoflurane on proliferation was evaluated by MTT, and cell migration assay, cell apoptosis, and invasion ability were evaluated by wound-healing assay, cell apoptosis, and Transwell assays. Insulin-like growth factor-1 (IGF-1) and PI3K/AKT signaling pathway gene expression in sevoflurane-treated cell lines was measured by western blotting analysis, respectively. 5% sevoflurane significantly inhibited proliferation ability in both U251 and U87 cells. Sevoflurane inhibited glioma cells invasion and migration, and promoted apoptosis. Sevoflurane inhibited IGF-1 and promoted the expression of apoptosis-related proteins in glioma cells. In addition, sevoflurane inhibited the PI3K/AKT signaling pathway in glioma cells. This study clarifies that sevoflurane inhibits proliferation, invasion, and migration, and promotes apoptosis in glioma cells. These effects are regulated by IGF-1, an upstream gene of the PI3K/AKT signaling pathway. These findings may be significant for the selection of anesthetic agents in glioma surgery to improve the prognosis of patients.

目的 对比免气管插管和传统双腔气管插管胸腔镜肺大疱切除术的安全性和可行性.方法 2016年6月～2018年5月,行免气管插管胸腔镜肺大疱切除术50例(免管组),同期行全麻双腔气管插管胸腔镜肺大疱切除术50例(插管组),2组术前临床资料差异无统计学意义,比较2组麻醉和手术指标.结果 2组均顺利完成手术,与插管组比较,免管组术前麻醉准备时间短[(17.6±3.0)min vs.(41.5±5.4)min,t=27.130,P=0.000],术后苏醒时间短[(22.0±4.0)min vs.(40.6±6.0)min,t=18.330,P=0.000],胸管引流时间短[(22.3±5.5)h vs.(24.6±4.3)h,t=2.328,P=0.022],术后住院时间短[(2.2±0.7)d vs.(2.8±0.4)d,t=4.681,P=0.000],麻醉费用少[(1896.0±310.5)元vs.(3734.0±359.3)元,t=27.370,P=0.000].结论 免气管插管的胸腔镜肺大疱切除术具有安全、便捷的优点,可以减少麻醉副作用,缩短住院时间,降低医疗费用,符合快速康复理念.

BACKGROUND:The analgesic effect of fascia iliaca compartment block (FICB) versus no block (NB) after lower limb surgery (LLS) is still controversial, so we performed this meta-analysis.MATERIALS AND METHODS:By searching the PubMed, Embase and the Cochrane Library (last update by July 20, 2017), randomized controlled trials comparing the analgesic effect of FICB versus NB in patients receiving LLS were identified. The primary outcome was the pain scores at 4, 12, and 24 h after LLS. The dosage of morphine at 24 h was also collected. The side effect of anesthesia was assessed according to the occurrence rate of postoperative nausea and vomiting.RESULTS:Data from 7 clinical trials that included 508 patients were summarized. The results showed that patients receiving FICB had lower pain scores at 4 h (mean difference [MD]=-1.17; 95% CI=-2.30 to -0.05; P=0.041), 12 h (MD=-0.41; 95% CI=-0.76 to -0.05; P=0.026) and 24 h (MD=-0.96; 95% CI=-1.77 to -0.15; P=0.020) after LLS. Besides, FICB could reduce the dosage of morphine at 24 h (MD=-2.06; 95% CI=-3.82 to -0.30; P=0.022) and the incidence of postoperative nausea and vomiting (relative risk rate=0.44, 95% CI=0.24-0.80, P=0.008).CONCLUSION:Compared with NB, FICB is an effective and safe method for alleviating the pain after LLS. More high-quality randomized controlled trials are needed to confirm this finding.