Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 0 0 2026 08 19 1 16 Li Chen Department of Anesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China Di Chen Department of Anesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China Qian Ruan Department of Anesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China Huafen Zi Department of Anesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China 2026 02 25 2026 04 02 Minimally invasive lung surgery still triggers significant inflammatory and immunosuppressive responses. This retrospective cohort study (January 2021–December 2023) assessed whether erector spinae plane block (ESPB) improves perioperative immune/cytokine balance in lung cancer patients undergoing elective minimally invasive surgery (ESPB, n=58; control, n=65). Compared with controls, the ESPB group demonstrated superior perioperative outcomes. Hemodynamics at incision were more stable (MAP: 103.24±9.85 vs 112.40±11.23 mm Hg, HR: 86.17±7.91 vs 94.74±9.05 beats/min), and opioid consumption was significantly lower (intraoperative sufentanil: 33.12±3.93 vs 36.75±5.08 μg). Postoperative pain scores were reduced (resting VAS at 1 hour: median 2 vs 4), comfort scores higher (BCS at 1 hour: median 2 vs 1), and patient-controlled analgesia use less frequent (total PCA demands at 48 hours: 18.55±5.14 vs 23.45±5.97). Immunologically, the ESPB group showed significantly attenuated suppression of cellular immunity, with higher CD3+ (60.92±4.74% vs 56.53±3.27% at 48 hours), CD4+ (38.16±4.29% vs 34.18±4.06% at 48 hours), CD4+/CD8+ ratio (1.23±0.17 vs 1.02±0.23 at 48 hours), and NK cells (21.03±3.45% vs 18.27±2.78% at 48 hours). The cytokine response was also modulated favorably: the rise in proinflammatory IL-6 (26.82±4.65 vs 32.55±5.21 pg/mL at 24 hours) and TNF-α (54.86±7.12 vs 61.55±6.01 pg/mL at 24 hours) was lower, while the anti-inflammatory IL-10 was higher in the ESPB group (28.12±4.43 vs 24.55±5.44 pg/mL at 24 hours). Clinically, the ESPB group experienced a lower incidence of postoperative dizziness (3.45% vs 13.85%), earlier ambulation (24.36±4.24 vs 27.55±5.17 hours), and a shorter hospital stay (15.16±1.83 vs 17.54±2.39 days). https://ijaai.tums.ac.ir/index.php/ijaai/article/view/4761 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/4761/2392