Postoperative Analgesic Comparison of SPSI Block and SAP Block in Video-Assisted Thoracoscopic Surgery (VATS)

Comparison of the Postoperative Analgesic Effectiveness of Serratus Posterior Superior Intercostal Plane Block and Serratus Anterior Plane Block in Video-Assisted Thoracoscopic Surgery (VATS)

In our study, we primarily aimed to compare the postoperative analgesic effectiveness of the Serratus Posterior Superior Intercostal Plane Block and the Serratus Anterior Plane Block, both routinely applied in patients undergoing Video-Assisted Thoracoscopic Surgery (VATS)

Study Overview

• Status: Not yet recruiting
• Conditions: Acute Post Operative Pain
• Intervention / Treatment: Procedure: Serratus Posterior Superior Intercostal Plane Block; Procedure: Serratus Anterior Plane Block

Detailed Description

In Video-Assisted Thoracoscopic Surgery (VATS), the thoracic cavity is visualized through a small incision in the chest wall. VATS allows for procedures such as lobectomy, bullectomy, and wedge resection. Compared to thoracotomy, VATS offers lower costs, better pulmonary function, less pain, and earlier postoperative mobilization. The success of postoperative rehabilitation in thoracic surgery patients can be improved with minimally invasive procedures and effective pain control.

The multimodal analgesic approach, which involves the combined use of analgesic drugs with different mechanisms (NSAIDs, paracetamol, opioids, etc.) along with regional/local techniques, aims to achieve additive and synergistic effects. This approach reduces the need for high doses of a single analgesic, minimizes side effects, and provides more effective pain control.

Investigators routinely apply opioids, NSAIDs, paracetamol, intravenous patient-controlled analgesia (PCA) devices, and regional techniques such as thoracic paravertebral block, serratus anterior plane block (SAPB), serratus posterior superior intercostal plane block (SPSIPB), and erector spinae plane (ESP) block for postoperative pain management in VATS patients.

The primary objective of this study is to compare the effects of Serratus Posterior Superior Intercostal Plane Block (SPSIPB) and Serratus Anterior Plane Block (SAPB), both routinely used in thoracic anesthesia practice, on postoperative pain scores and analgesic needs in VATS patients.

The SAPB, which is an essential component of multimodal analgesia in thoracic surgery, offers safe and precise analgesic effects with low complication rates. The block covers most VATS incisions and chest tube sites, providing better postoperative analgesia and potentially improving lung function. Similarly, SPSIPB, another thoracic wall fascial plane block, has been shown to be effective in managing both acute and chronic pain. It is reported to provide good analgesia in the thoracic region after VATS.

The study will include patients aged 18-80 years scheduled for VATS at Uludağ University Medical Faculty Hospital. Patients with ASA I, II, and III classifications will be included.

Patients will be randomized into two groups:

Group 1: SPSIPB (n=45) Group 2: SAPB (n=45) Both blocks will be applied after standard anesthesia induction, intubation, surgical positioning, and before surgical incision.

During the intraoperative period, if heart rate or mean arterial pressure (MAP) increases by more than 20% from baseline measurements, IV fentanyl (1 µg/kg) will be administered as needed. Prior to the surgical incision, all patients will receive IV paracetamol (10 mg/kg), tenoxicam (20 mg), and metoclopramide (10 mg) as part of routine practice.

Fifteen minutes before awakening, a patient-controlled analgesia (PCA) device will be connected to each patient. The PCA device will be prepared with 1 mg/ml morphine solution, with a bolus dose of 2 ml and a lockout interval of 15 minutes. In patients with an NRS score of ≥4, IV tramadol (100 mg/2 ml) will be administered as a rescue analgesic. The pain score at the time of rescue analgesia, the time of the first PCA request, and the NRS score at that time will be recorded.

• Study Type: Interventional
• Enrollment (Estimated): 90
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Patients aged 18 to 80 years undergoing Video-Assisted Thoracoscopic Surgery (VATS)
• Scheduled at Uludağ University Faculty of Medicine Hospital Operating Room
• Classified as ASA I, II, or III according to the American Society of Anesthesiologists (ASA) criteria

Exclusion Criteria:

• Allergy to local anesthetics or contraindications to bupivacaine
• Known or suspected coagulopathy
• Infection at the injection site
• History of thoracic surgery
• Severe neurological or psychiatric disorders
• Severe cardiovascular disease
• Liver failure
• Renal failure (glomerular filtration rate < 15 ml/min/1.73 m²)
• Chronic opioid use

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Serratus Posterior Superior Intercostal Plane Block Group; In this group, the ultrasound device with a linear probe (38 mm, 6 MHz) will be used. The upper medial border of the scapula on the side of the planned surgery will be identified between the 2nd and 7th ribs. A block needle will be inserted medially to the scapula, advancing into the plane between the serratus posterior superior muscle and the intercostal muscles. A total of 30 ml of 0.25% bupivacaine will be injected, with a maximum dose of 2 mg/kg/day. In other words, the injection will be applied under the SPS muscle, between the rib and the SPS muscle.	Procedure: Serratus Posterior Superior Intercostal Plane Block; Patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) will receive either a Serratus Posterior Superior Intercostal Plane Block (SPSIPB) with bupivacaine after induction and before the surgical procedure begins.
Active Comparator: Serratus Anterior Plane Block Group; In this group, the ultrasound device with a linear probe (38 mm, 6 MHz) will be used. The probe will be placed between the anterior and posterior axillary lines, on the side of the planned surgery, between the 2nd and 7th ribs. The block needle will be advanced to the surface or deeper part of the serratus anterior muscle, into the fascial plane. A total of 30 ml of 0.25% bupivacaine will be injected, with a maximum dose of 2 mg/kg/day, underneath the serratus anterior muscle.	Procedure: Serratus Anterior Plane Block; Patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) will receive either a Serratus Anterior Plane Block (SAPB) with bupivacaine after induction and before the surgical procedure begins.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Numerical Rating Scale (NRS)	Numerical Rating Scale (NRS) The Numerical Rating Scale (NRS) is a commonly used pain assessment tool that allows patients to rate their pain intensity on a scale from 0 to 10. 0 indicates no pain. 10 indicates the worst possible pain. Patients are asked to choose a number that best represents their pain level at the time of assessment.	2 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to First Mobilization of Patients	Time to first mobilization refers to the time when patients first stand up, sit, or walk after surgery. It is a crucial indicator of postoperative recovery and is commonly used to assess the effectiveness of pain management and the patient's overall condition after the procedure. Clinical Importance: Early mobilization helps reduce postoperative complications such as deep vein thrombosis (DVT), pulmonary infections, and pressure ulcers. It accelerates recovery and contributes to earlier discharge from the hospital. It provides an important metric to evaluate pain management and the patient's physical recovery.	2 day
5-point Likert scale	Patient satisfaction after the procedure was evaluated using a 5-point Likert scale, ranging from 1 (Strongly Dissatisfied) to 5 (Strongly Satisfied)	2 day

Collaborators and Investigators

• Sponsor: Uludag University

Study record dates

Study Major Dates

• Study Start (Estimated): May 15, 2025
• Primary Completion (Estimated): February 9, 2026
• Study Completion (Estimated): February 10, 2026

Study Registration Dates

• First Submitted: January 12, 2025
• First Submitted That Met QC Criteria: January 12, 2025
• First Posted (Actual): January 16, 2025

Study Record Updates

• Last Update Posted (Actual): May 15, 2025
• Last Update Submitted That Met QC Criteria: May 12, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pain, Postoperative
• Other Study ID Numbers: UU-AN-RBC-01

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No