Comparison of Erector Spinae Plane Block and Serratus Posterior Superior Intercostal Plane Block for Postoperative Analgesia After Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial

This prospective randomized controlled trial was conducted to compare the effectiveness of two ultrasound-guided regional anesthesia techniques, erector spinae plane block (ESPB) and serratus posterior superior intercostal plane block (SPSIPB), with standard patient-controlled analgesia (PCA) for postoperative pain management after video-assisted thoracoscopic surgery (VATS).

Adult patients undergoing elective VATS were randomly assigned to receive ESPB, SPSIPB, or PCA alone. The primary objective was to evaluate postoperative pain intensity during the first 48 hours after surgery. Secondary outcomes included opioid consumption, rescue analgesia requirements, patient satisfaction, and postoperative complications.

Study Overview

• Status: Completed
• Conditions: Postoperative Pain; Thoracic Surgery, Video Assisted
• Intervention / Treatment: Procedure: Erector Spinae Plane Block (ESPB) group; Procedure: Serratus posterior superior intercostal plane block; Drug: Morfin

Detailed Description

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique; however, postoperative pain remains clinically significant and may delay recovery and increase opioid consumption. Ultrasound-guided fascial plane blocks have been increasingly incorporated into multimodal analgesia strategies in thoracic surgery.

This single-center, prospective, randomized controlled study included adult patients aged 18-75 years with ASA physical status I-III who were scheduled for elective VATS. After obtaining written informed consent and ethics committee approval, patients were randomly assigned in a parallel design to one of three groups: ESPB group, SPSIPB group, or control group receiving morphine patient-controlled analgesia (PCA) alone.

Both ESPB and SPSIPB were performed preoperatively under ultrasound guidance by an experienced anesthesiologist prior to induction of general anesthesia. Standardized general anesthesia and postoperative analgesia protocols were applied to all patients.

The primary outcome was postoperative pain intensity assessed using the Numeric Rating Scale (NRS, 0-10) at predefined time points up to 48 hours postoperatively. Secondary outcomes included cumulative morphine consumption, number of morphine demands, rescue analgesia requirements, patient satisfaction, and opioid-related adverse events.

The study aimed to determine whether SPSIPB provides analgesic efficacy comparable to ESPB and whether both regional techniques reduce opioid consumption compared with PCA alone.

• Study Type: Interventional
• Enrollment (Actual): 110
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye)
    • Marmara University Faculty of Medicine Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 18 and 75 years
• American Society of Anesthesiologists (ASA) physical status I-III
• Scheduled for elective video-assisted thoracoscopic surgery (VATS)
• Ability to understand and use patient-controlled analgesia device
• Provided written informed consent

Exclusion Criteria:

• - Coagulation disorders or current anticoagulant therapy
• Infection at the block application site
• Known allergy to local anesthetic agents
• Anatomical abnormalities interfering with ultrasound-guided block
• Severe cardiac, renal, or hepatic failure
• Neurological or cognitive impairment preventing reliable pain assessment
• Emergency surgery

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ESPB Group; Patients received ultrasound-guided erector spinae plane block prior to induction of general anesthesia in addition to standard postoperative PCA.	Procedure: Erector Spinae Plane Block (ESPB) group; Ultrasound-guided erector spinae plane block performed preoperatively using local anesthetic.
Experimental: SPSIPB Group; Patients received ultrasound-guided serratus posterior superior intercostal plane block prior to induction of general anesthesia in addition to standard postoperative PCA.	Procedure: Serratus posterior superior intercostal plane block; Ultrasound-guided serratus posterior superior intercostal plane block performed preoperatively using local anesthetic.
Active Comparator: PCA Group; Patients received standard postoperative morphine patient-controlled analgesia without regional block.	Drug: Morfin; Intravenous morphine administered via patient-controlled analgesia device.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative pain intensity	Postoperative pain assessed using the Numeric Rating Scale (NRS, 0-10), where 0 indicates no pain and 10 indicates worst imaginable pain.	0 to 48 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cumulative morphine consumption	Total amount of intravenous morphine administered via patient-controlled analgesia device.	0 to 48 hours postoperatively
Rescue analgesia requirements		12 hours postoperatively

Collaborators and Investigators

• Sponsor: Marmara University

Study record dates

Study Major Dates

• Study Start (Actual): March 2, 2025
• Primary Completion (Actual): July 31, 2025
• Study Completion (Actual): July 31, 2025

Study Registration Dates

• First Submitted: February 15, 2026
• First Submitted That Met QC Criteria: February 15, 2026
• First Posted (Actual): February 23, 2026

Study Record Updates

• Last Update Posted (Actual): February 23, 2026
• Last Update Submitted That Met QC Criteria: February 15, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Population Characteristics; Demography; Population Groups
• Other Study ID Numbers: 09.2025.25-0167

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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