Table 1 Summary of findings table

Rahimzadeh P (2022) [11]

Iran

20–60

I-II

20 ml of ropivacaine 0.25%

20 ml of ropivacaine 0.25%

Preoperative vs. Postoperative

PREMEDICATION: FNT 2 μg/kg, MDZ 0.12 mg/kg INDUCTION: PRP 2 mg/ kg and cisatracurium 0.2 mg/kg MAINTENANCE: Isoflurane 1MAC (1.2%), cisatracurium 2 mg every 30 min

PCA: 20 mg/ml of Acetaminophen and 0.6 mg/ml of Ketorolac with a bolus of 2 ml every 15 min

Postoperative Pain

Arik E (2020) [22]

Turkey

18–80

I-III

20 mL 0.25% bupivacaine

–

Preoperative

PREMEDICATION: MDZ 0.03 mg/kg INDUCTION: PRP 2.5 mg/kg; FNT 1 mcg/kg; ROC 0.6 mg/kg MAINTENANCE: SEVO 1% MAC

PCA: tramadol (5 mg/mL) 20 mg bolus, 20 min lock-out time, and a maximum infusion rate of 200 mg in 4 h without basal infusion. Dexketoprofen 50 mg IV for rescue when NRS > 4

Postoperative Pain

Dost B (2018) [23]

Turkey

20–70

I-II

levobupivacaine 0.5% 15 mL+ saline 15 mL

–

Preoperative

PREMEDICATION: MDZ 0.03 mg/kg INDUCTION: PRP 2.5 mg/kg; FNT 1 mcg/kg; ROC 0.6 mg/kg MAINTENANCE: SEVO 1% MAC

PCA: tramadol (5 mg/mL) 20 mg bolus, 15 min lock-out time, and a maximum infusion rate of 200 mg in 4 h with basal infusion of 5 mg/h. Meperidin 0.5 mg/kg IV for rescue when NRS > 4

Postoperative Pain

Bhatia N (2014) [24]

India

18–60

I-II

ropivacaine 0.375% 15 ml

–

Postoperative

PREMEDICATION: alprazolam 0.25 mg + ranitidine 250 mg; INDUCTION: morphine 0.1 mg/kg PRP 2–3 mg/kg vecuronium 0.1 mg/kg; MAINTENANCE: N2O 66% +/− Isoflurane 1–2%

IV paracetamol 1 g every 6 hours, VAS score greater than 4, or those requesting analgesic, were given IV tramadol 2 mg/kg; subsequent doses of tramadol, if required, were 1 mg/kg

Postoperative Pain

Ortiz J (2012) [25]

USA

18–64

I-III

ropivacaine 0.5% 15 ml

ropivacaine 0.5% 20 ml

Preoperative

PREMEDICATION: MDZ 1–2 mg, INDUCTION: FNT 2 mcg/kg and PRP 2.5 mg/kg, succinylcholine 1–2 mg/kg or ROC 0.6–1 mg/kg, MAINTENANCE: SEVO, additional boluses of FNT 50 mcg

Hydrocodone 5 mg, acetaminophen 500 mg tablets, 2 tablets for mild pain (NRS 3–5), and morphine 4 mg iv for severe pain (NRS 6–10)

Postoperative Pain

Suseela I (2018) [26]

India

20–65

I-II

bupivacaine 0.25% 20 ml

bupivacaine 0.5% 20 mL (each port 5 mL)

Postoperative

PREMEDICATION: ranitidine 150 mg; metoclopramide 10 mg; MDZ 0.5 mg INDUCTION: PRP 2 mg/kg FNT 2 mcg/kg; succinylcholine 1.5 mg/kg MAINTENANCE: nitrous oxide 66%; isoflurane 0.4 to 0.8%; atracurium 0.5 mg/kg

Paracetamol 1 g at the beginning and 1 g/8 h (postoperative);tramadol 1 mg /kg and diclofenac 1 mg/kg

Postoperative Pain

Vrsajkov V (2018) [27]

Serbia

18–75

I-III

20 mL of 0.33% bupivacaine

–

Preoperative

INDUCTION: PRP (2.5 mg/kg), FNT (3 mcg/kg) and ROC (0.6–0.8 mg/kg) MAINTENANCE: SEVO.

acetaminophen (1 g IV) and morphine (0.1 mg.kg − 1 s), acetaminophen (1 g/8 h IV) and dipyrone (2.5 g/12 h; tramadol (1 mg.kg − 1 /6 h) NPS ≥ 6

Postoperative Pain

Ribeiro KNSA (2019) [28]

India

18–55

I-II

40 mL of 0.35% ropivacaine

–

Preoperative

PREMEDICATION: FNT 2 mcg/kg I.V. INDUCTION: PRP 2 mg/kg IV, 0.1 mg/kg of vecuronium I.V. MAINTENANCE: Vecuronium 0.02 mg/kg iv, air and oxygen and SEVO 1.5–2.0 dial concentration MAC of 1.

paracetamol 1 g IV at extubation and 8th hourly, Tramadol 1 mg/kg was given IV whenever VAS was ≥4

Postoperative Pain

Ra YS (2010) [29]

Korea

20–65

I-II

0.25% levobupivacaine 30 mL

–

Preoperative

PREMEDICATION: none, INDUCTION: glycopyrolate 0.2 mg and MDZ 0.05 mg/kg and introducing 2% PRP and REM 50 μg/ml, ROC 0.6 mg/kg MAINTENANCE: oxygen and nitrous oxide, PRP at 2 μg/ ml

PACU: NRS > 6 ketorolac 30 mg IV, If the pain was not relieved, FNT 20 μg; in WARD: ketorolac 30 mg was injected into all the patients 3 times during postoperative 24 hours for 8 hour

Postoperative Pain

Dai LM (2022) [30]

China

> 18

I-II

20 mL 0.5% ropivacaine

Postoperative

INDUCTION: MDZ (0.05 mg/kg), SUF (0.03 μg/kg), ETM (0.3 mg/kg), and cisatracurium (0.15 mg/kg), MAINTENANCE: PRP (6 mg/ kg/h) and REM (0.3 μg/kg/min)

100 mL of normal saline mixed with SUF (100 μg) and dezocine (20 mg); basal inf. 2 mL/h, bolus dose was 0.5 mL, and a lockout interval of 15 min

Morphine Consumption

Al-Refaey K (2016) [31]

Egypt

18–40

I-II

20 ml volume 0.25 bupivacaine

Preoperative

INDUCTION: PRP 1–1.5 mg/kg, FNT 1 μ/kg, and atracurium 0.5 mg/kg, MAINTENANCE: SEVO, 0.4 oxygen/air mixture

morphine (0.02 mg/kg) if VAS score ≥ 4

Recruitment Rate. Adherence Rate. Adverse Events Rate

Lee SY (2022) [32]

Korea

20–70

I-II

40 ml of 0.375% ropivacaine

saline

Postoperative

PREMEDICATION: none, INDUCTION: lidocaine (0.5 mg/kg), PRP (2 mg/ kg), REM (0.5 mcg/kg), and ROC (0.6 mg/kg), MAINTENANCE: oxygen (fraction of inspired oxygen, 0.5), SEVO (2–3%), and REM infusion (0.1 mcg/kg/min)

continuously infuse 0.2 mcg/kg of FNT every hour, and the bolus dose was 0.2 mcg/kg with a 15-min lockout time

Postoperative Pulmonary Function And Analgesia

Jung J (2021) [33]

Korea

20–60

I-III

0.25% ropivacaine

saline

Preoperative

INDUCTION: PRP 4–6 μg/mL and REM 2–6 μg/mL, ROC 0.6–1.0 mg/kg, MAINTENANCE: PRP, REM

PACU: NRS score was > 3, the nurse injected 3-mg IV oxycodone; at ward,30 mg IV ketorolac/8 h at POD0; From POD 1, per-os 50 mg tramadol was administered every 8 hours

Quality Of Recovery

Baral B (2018) [34]

Nepal

18–60

I-II

20 ml of 0.25% Bupivacaine

20 ml of 0.25% Bupivacaine

Postoperative

induction: FNT (2 mcg/kg), PRP (2 mg/kg), and vecuronium (0.8 mg/kg), MAINTENANCE: oxygen, isoflurane, intermittent dose of vecuronium

Paracetamol 1 g 6 hourly; VAS ≥4 pethidine 0.5 mg/kg

Postoperative Pain

Basaran B (2015) [35]

Turkey

18–65

I-II

bupivacaine 0.25% 20 ml

–

Preoperative

PREMEDICATION: MDZ 0.03 mg/kg INDUCTION: FNT 1 μg/kg, MDZ 0.15 mg/kg, PRP 1–2 mg/kg, ROC 1 mg/kg. MAINTENANCE: SEVO, ROC infusion (0.01 mg/kg/min) and FNT (2–3 μg/kg/h).

meperidine 0.5 mg/kg; paracetamol 500 mg po every 6 hours; tenoxicam 20 mg; tramadol 50 mg + 50 mg (when needed) (max dose 500 mg/24 h)

Postoperative Pain

El-Dawlatly AA (2009) [36]

Austria

22–77

I-II

15 mL bupivacaine

–

Preoperative

PREMEDICATION: diazepam 10 mg po INDUCTION: PRP 1–1.5 mg/kg; FNT 2 mcg/kg; ROC 0.6 mg/kg MAINTENANCE: SEVO 1 MAC; REM 0.1 mcg/kg/min

PCA: 1.5 mg bolus morphine without basic rate, 15 min locout time

Postoperative Morphine Consumption

Peterson PL (2012) [37]

Denmark

18–75

I-III

20 mL 0.5% ropivacaine

isotonic saline 0,9% 20 mL

Preoperative

PREMEDICATION: Oral lorezepam 2 mg, INDUCTION: SUF 0.2 mcg/kg, PRP 4 mg/kg, ROC 1 mg/kg MAINTENANCE: SEVO

acetaminofen 1000 mg, every 6 hours, oral ibuprofen 400 mg every 6 hours, iv morphine 5 mg request patient(0–2 hours), 2–24 hours ketobemidone oral 2.5 mg patient own decision

Postoperative Pain

Houben AM (2019) [38]

Belgium

18–75

I-II

levobupivacaine 20 mL 0.375% with epinephrine 5 mcg/mL

saline 20 mL 0.9% with epinephrine 5 mcg/mL

Preoperative

INDUCTION: REM 0,4 mL/kg/h (0.6 mg/mL) PRP, MAINTENANCE: PRP, REM 0.4 mL/kg/h SUF 0.2 mcg/kg

paracetamol 2 g, iv morphine 2 mg bolus,oxycodone 5 mg every 4 hours if necessary

Cumulative Morphine Consumption

Liang M (2020) [39]

China

18–70

I-II

ropivacaine 0.75% 20 mL

20 mL saline 0,9%

Preoperative

INDUCTION: PRP 2 mg/kg, SUF 0.1 mcg/kg, ROC 0.6 mg/kg MAINTENANCE: SEVO 1–2%

parecoxib 40 mg, morphine 2.5 mg for PACU patients, tramadol 100 mg PO for those in the ward

Postoperative Pain

Shin HJ (2014) [40]

USA

18–65

I-II

no block

ropivacaine 20 mL 0.375%

Preoperative

INDUCTION: PRP 1.5 mg/kg, FNT1 mcg/kg, ROC 0.6 mg/kg MAINTENANCE: SEVO

ketorolac 30 mg, if NRS pain score exceeded 6 add FNT 25 mcg,if 4–6, ketorolac 30 mg, on the ward nalbuphine 10 mg (if exceeded 6 or or patient requested)

Postoperative Pain

Breazu C (2022) [41]

Romania

> 18

I-II

bupivacaine 0.25% 20 ml

no block

Preoperative

INDUCTION: PRP 2 mg/kg FNT 2mcg/kg atracurium 0.5 mg/kg or ROC 0.6 mg/kg MAINTENANCE: SEVO

Postoperative Pain

Andic KD (2021) [42]

Turkey

18–75

I-III

bupivacaine 0.375% 20 ml

no block

Preoperative

PREMEDICATION:MDZ 0.03 mg/kg INDUCTION: FNT 2 mcg/kg PRP 1–2 mg/kg ROC 0.6 mg/kg MAINTENANCE: SEVO 1 mac REM 0.1–0.5 mcg/kg/min

PCA: tramadol 500 MG basal infusion 3 mL/h bolus 3 mL lockout time 20 min

Postoperative Pain

Chen CK (2013) [43]

Hong Kong

21–60

I-II

ropivacaine 20 mL 3.75 mg/mL

no block

Preoperative

PREMEDICATION: oral MDZ 7,5 mg INDUCTION: FNT 2mcg/kg PRP 1–2 mg/kg Vecuronium 0.1 mg/kg MAINTENANCE: SEVO; vecuronium 0.05 mg/kg

if VAS score more than 4, morphine 0.05 mg/kg

Morphine Consumption

Tolchard S (2014) [44]

England

> 16

I-II

bupivacaine 1 mg/kg

bupivacaine 1 mg/ kg port site

Postoperative

INDUCTION: PRP 2.5 mg/kg FNT 3 mcg/kg atracurium 0.6 mg/kg

intraoperative: paracetamol 15–20 mg/kg diclofenac 0.5 mg/kg, postoperative: FNT 20 mcg boluses

Postoperative Pain

Breazu CM (2016) [45]

Romania

> 18

I-II

saline 20 mL

bupivacaine 0.25% 20 mL

Preoperative

PREMEDICATION: MDZ 7.5 mg po INDUCTION: PRP 2 mg/kg FNT 2 mcg/kg; ROC 0.6 mg/kg or atracurium 0.5 mg/kg MAINTENANCE: SEVO 1–2 MAC FNT 100 mcg when needed

Acetaminofen 15–20 mg/kg and 1 g iv at 8 h, pethidine 20–40 mg boluses and 20–40 mg iv every 3 hours

Postoperative Pain

Huang SH (2016) [46]

China

I-II

ropivacaine 15 mL 0.375%

no block

Preoperative

INDUCTION: midozolam 0.05 mg/kg PRP 2% REM ROC 0.6 mg/kg MAINTENANCE: PRP 2 mcg/mL REM 2–4 ng/mL ROC if needed

40 mg iv parecoxib, iv sulfentanil 5–10 mcg

Postoperative Pain

Saliminia A (2015) [47]

Iran

bupivacaine 0.5% 30 mL + 2 mL saline

32 mL saline 0.9%

Postoperative

INDUCTION: PRP 2 mg/kg, FNT 3 mcg/kg, atracurium 0.6 mg/kg MAINTENANCE: PRP 80–100 mcg/kg/min, FNT 1 mcg/kg/ 30 min, atracurium 0.3 mg/kg/30 min

PCA: FNT 50 mcg bolus; lock out time 8 min

Postoperative Opioid Consumption

Ali L (2018) [48]

Pakistan

20–60

I-II

0.5% bupivacaine (1 mg/kg),

0.5% bupivacaine (1 mg/kg),

Postoperative

INDUCTION:iv Nalbuphine 0.1 mg/kg, PRP 2–2.5 mg/kg iv MAINTENANCE isoflurane in 50% oxygen with air

Nalbuphine 2 mg iv

Postoperative Pain

Bava P (2016) [49]

India

18–65

I-II

0.375% ropivacaine

0.25% bupivacaine

Preoperative

INDUCTION:PRP 2 mg/kg + FNT 2 μg/kg + atracurium 0.5 mg/kg MAINTENANCE: isoflurane

Morphine 0.05 mg/kg boluses given until the VAS score < 4 + PCA (1 mg bolus) + as rescue analgesia if VAS > 3 0.1 mg/kg of morphine I

Postoperative Pain

Paudal B (2022) [50]

Nepal

18–60

I-II

bupivacaine 20 mL 0.25%

bupivacaine 20 mL 0.25%

Postoperative

PREMEDICATION: ranitidine 150 mg po INDUCTION: MDZ 0,02 mg/kg FNT 2 mcg/kg PRP 2.5 mg/kg vecuronium 0.1 mg/kg MAINTENANCE: isoflurane 1–1.5% intermittent doses of ROC

Postoperative Pain

Emile SH (2022) [51]

Egypt

N/A

I-II

10 ml bupivacaine (0.25%) + lidocaine (%2) + 10 ml saline

no block

Postoperative

INDUCTION: PRP 2 mg/kg, atracorium 1 mg/kg, FNT 1 μg/kg

IV 1000 mg Paracetamol, if VAS > 4 iv diclofenac for rescue analgesic

postoperative pain

Choi Y (2017) [52]

Korea

19–70

I-II

20 mL of ropivacaine 0.2%

no block

Preoperative

PREMEDICATION: glycopyrrolate

(0.003 mg/kg) and MDZ (0.05 mg/kg) INDUCTION: thiopental sodium (5 mg/kg) and REM (1 μg/kg/min) ROC (0.8 mg/kg) MAINTENANCE: Desflurane (6 vol%) REM 0.5–1 μg/kg/min

IV-PCA: 100 mL of normal saline mixed with oxycodone (40 mg) and ketorolac (180 mg). The basal infusion rate was set to 1 mL/h, the bolus dose was 1 mL, and the lockout time was 15 min

postoperative pain

Prajapati K (2022) [53]

India

N/A

I-II

20 mL of 0.375% ropivacaine

no block

Postoperative

INDUCTION: FNT 2 mcg/kg, PRP 1.5–2.5 mg/kg and atracurium 0.5 mg/kg. MAINTENANCE: nitrous oxide (60%) and isoflurane (MAC: 0.8–1.2) in oxygen.

Paracetamol 1 g iv six hourly and inj. Diclofenac (75 mg/mL) 1 mL diluted in 100 mL normal saline iv 12 hourly. VAS ≥ 4 IV tramadol at an incremental dose of 2 mg/kg as rescue analgesia

postoperative pain

Ergin A (2021) [54]

Turkey

18–74

I-III

40 ml of bupivacaine 0.25%

no block

Preoperative

INDUCTION: 2–3 mg/kg PRP, 2 μg/kg

FNT, and 0.6 mg/kg ROC

MAINTENANCE:1.5–2% SEVO

VAS score of > 4 50 mg tramadol IV, and those with ongoing high pain after 30 min 100 mg tramadol, tenoxicam 20 mg IV postop 8 h, and 25 mg of meperidine IV as salvage analgesic

postoperative pain