Erector Spinae Plane Block Versus Serratus Anterior Plane Block in VATS (VATS)

May 21, 2025 updated by: Ain Shams University

A Comparative Study of Erector Spinae Plane Block Versus Serratus Anterior Plane Block for Postoperative Analgesia After Video-assisted Thoracoscopic Surgery

Pain control remains challenging in patients undergoing video-assisted thoracoscopic surgery (VATS). It is advised to use a regional block to lower postoperative opioid usage. This study evaluates efficacy of Erector spinae plane (ESP) block in comparison to Serratus anterior plane block (SAP) in pain management for patients undergoing video-assisted thoracoscopic surgery(VATS).

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Minimally invasive thoracic surgery (MITS) has become more common over the past decade, with the proportion of lung resections performed using this technique increasing from 16% in 2005 to 47% in 2015.

VATS is a minimally invasive procedure that allows rapid recovery compared to thoracic surgery. Patients scheduled for VATS experience moderate to severe pain following the procedure. This represents a significant burden peri-operatively as there is a strong relationship between poor pain control and the development of complications like pneumonia and atelectasis due to interference with spontaneous deep breathing & coughing. These complications have a negative impact on functional recovery; therefore, adequate postoperative pain relief assists in improving functional outcomes & accelerates hospital discharge.

Multimodal techniques for pain control have been recommended by The American Society of Anesthesiologists (ASA) for the management of acute postoperative pain. Traditional analgesia based on opioids have multiple adverse effects such as respiratory depression, nausea, vomiting, itching and dizziness.

SAP block was first described in 2013 by Blanco as an analgesic technique.it is proposed to block the lateral cutaneous branch of the intercostal nerve, long thoracic nerve, and dorsal thoracic nerve. The block range of the SAPB covers the incisions of video-assisted thoracoscopic surgery (VATS) and the site of the chest tube, which are often located in the antero-lateral chest wall. The local anaesthetic injection was described in two planes: the 'superficial plane' and deep plane.

An ultrasound-guided ESP block was firstly reported in 2016. The ESP block injects a local anaesthetic around the erector spinae muscle at approximately the level of the T5. It may be able to block the dorsal and ventral rami of the thoracic spinal nerves. The first report of the successful use of this procedure was in 2016; the block was used to manage thoracic neuropathic pain in a patient with metastatic disease of the ribs and rib fractures

Study Type

Interventional

Enrollment (Estimated)

40

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Egypt
      • Cairo, Egypt, 02
        • Recruiting
        • Faculty of medicine ain shams university
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • body mass index (BMI)=18 to 40 kg/m2

Exclusion Criteria:

  • Contraindications to regional anesthesia as bleeding disorders , allergy to local anesthetic or infection at block site
  • pre-existing chronic pain
  • history of opiate abuse
  • sepsis

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Group A: Erector spinae block group
After selecting the target transverse process for the nerve block, place the transducer in a paramedian sagittal orientation, approximately 2cm away from the midline (spinous processes), and try to vizualize the transverse process at the level of T5 Complete the nerve block with 30ml of 0.25% levobupivacaine for erector spinae block
Procedure: Erector Spinae Plane Block (ESPB) group
30ml of 0.25% levobupivacaine for erector spinae block at level of T5
Active Comparator: group B: Serratus anterior block group

High-frequency linear transducer should be placed on the patient's midaxillary line in the transverse plane, at the level of the fifth rib. With the rib, pleural line, and overlying serratus anterior and latissimus dorsi muscles visualized.

Then, using ultrasound guidance, the needle is advanced in-plane and the local anesthetic is injected anteriorly to the rib and deep to the serratus anterior.

After opening the fascial plane, a volume of dilute local anesthetic, 30 mL of 0.25% levobupivacaine, should be gradually injected.
Procedure: Serratus Anterior Plane Block (SAPB) group
30 mL of 0.25% levobupivacaine injected anteriorly to the rib and deep to the serratus anterior at level of 5 th rib

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
post operative opioid consumption
Time Frame: 24 hours post operative
post operative meperidine consumption throughout
24 hours post operative

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
intraoperative fentanyl consumption
Time Frame: during the surgery
total introperative fentanyl dose
during the surgery
the numerical rating scale
Time Frame: 24 hours post operative
a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0 to 10 integers) that best reflects the intensity of their pain. 0 representing one pain extreme (e.g., "no pain") and 10 representing the other pain extreme (e.g., "pain as bad as you can imagine" and "worst pain imaginable")
24 hours post operative

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Ain Shams University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 1, 2025

Primary Completion (Estimated)

July 31, 2025

Study Completion (Estimated)

August 15, 2025

Study Registration Dates

First Submitted

May 6, 2025

First Submitted That Met QC Criteria

May 21, 2025

First Posted (Actual)

May 30, 2025

Study Record Updates

Last Update Posted (Actual)

May 30, 2025

Last Update Submitted That Met QC Criteria

May 21, 2025

Last Verified

February 1, 2025

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • FMASU MS 145/2025

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ICF

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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