Effect of Early Versus Late Surgical Intercostal Block on Postoperative Pain Relief Following Video-Assisted Thoracic Surgery (VATS)

Effect of Early Versus Late Surgical Intercostal Block on Postoperative Pain Relief Following Video-Assisted Thoracic Surgery (VATS): a Randomised, Double-blind Study

Video-assisted thoracoscopic surgery (VATS) is associated with significant postoperative pain despite lower morbidity compared with thoracotomy. Adequate pain management is essential within Enhanced Recovery After Surgery (ERAS) pathways to preserve respiratory function and facilitate postoperative recovery. Surgical intercostal block performed under direct vision is a simple and effective regional analgesic technique commonly used following VATS. However, the optimal timing of intercostal block administration during surgery remains uncertain.

This prospective randomized double-blind study will compare surgical intercostal block performed at the beginning versus the end of the surgical procedure. The study aims to evaluate the effect of block timing on postoperative pain intensity and postoperative opioid consumption. The results may help optimize multimodal analgesic strategies in patients undergoing thoracic surgery.

Study Overview

• Status: Not yet recruiting
• Conditions: Video Assisted Thoracic Surgery (VATS); Intercostal Nerve Block
• Intervention / Treatment: Procedure: Intercostal nerve block before (ropivacaine 0.375%); Procedure: ICNB after (physiological serum); Procedure: Intercostal Nerve Bloc before (physiological serum); Procedure: ICNB after (ropivacaine 0.375%)

• Study Type: Interventional
• Enrollment (Estimated): 140
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Celine Boudart; Phone Number: +3225553919; Email: celine.boudart@hubruxelles.be

Study Locations

• Belgium
  • Brussels, Belgium
    • HUB Erasme
    • Contact: Celine Boudart; Phone Number: +3225553919; Email: celine.boudart@hubruxelles.be

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Age ≥ 18 years
• Scheduled for single-port or two-port video-assisted thoracoscopic surgery (VATS).
• ASA classification 1 to 3
• Able to understand the study, describe their pain and provide valid informed consent

Exclusion Criteria:

• Neurological or psychiatric conditions that compromise the reliable assessment of pain(dementia, cognitive impairment, severe communication disorders)
• Chronic opioid use or regular use (> 3 months) of strong analgesics for chronic pain
• History of allergy or known hypersensitivity to local anaesthetics
• Coagulopathy or anticoagulant therapy precluding the safe performance of an intercostal block
• Local infection at the injection site or active systemic infection
• Bilateral thoracic surgery or intraoperative conversion to thoracotomy
• Second surgery at the same site.
• Current pregnancy or breastfeeding
• Inability to understand postoperative instructions or a language barrier preventing a validated assessment of pain
• Simultaneous participation in another clinical trial involving analgesia or thoracic surgery
• Refusal to participate or withdrawal of consent at any time

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ICNB before incision	Procedure: Intercostal nerve block before (ropivacaine 0.375%); All patients will receive two intercostal nerve blocks using the same injection volume and technique. Intercostal nerve blocks will be performed twice: before surgical incision and at the end of the procedure. In both study groups, one injection will contain ropivacaine 0.375% and the other will contain normal saline. In the interventional arm, the pre-incision intercostal nerve block will contain the local anesthetic, whereas the end-of-procedure intercostal nerve block will contain normal saline. In the comparator arm, the pre-incision intercostal nerve block will contain normal saline, whereas the end-of-procedure intercostal nerve block will contain the local anesthetic.; Procedure: ICNB after (physiological serum); All patients will receive an intercostal nerve block using the same local anesthetic (ropivacaine 0.375%). ICNB will be performed twice: before surgical incision and at the end of the procedure. In the interventional arm, the ICNB before surgery will contain the local anesthetic, and the ICNB after surgery will contain normal saline. In the comparator arm, the ICNB before surgery will contain normal saline, and the ICNB after surgery will contain the local anesthetic.
Active Comparator: ICNB at the end of surgery	Procedure: Intercostal Nerve Bloc before (physiological serum); All patients will receive intercostal nerve blocks using the same local anesthetic (ropivacaine 0.375%). Intercostal nerve blocks will be performed twice: before surgical incision and at the end of the procedure. In the interventional arm, the pre-incision intercostal nerve block will contain the local anesthetic, whereas the end-of-procedure intercostal nerve block will contain normal saline. In the comparator arm, the pre-incision intercostal nerve block will contain normal saline, whereas the end-of-procedure intercostal nerve block will contain the local anesthetic.; Procedure: ICNB after (ropivacaine 0.375%); All patients will receive intercostal nerve blocks using the same local anesthetic (ropivacaine 0.375%). Intercostal nerve blocks will be performed twice: before surgical incision and at the end of the procedure. In the interventional arm, the pre-incision intercostal nerve block will contain the local anesthetic, and the end-of-procedure intercostal nerve block will contain normal saline. In the comparator arm, the pre-incision intercostal nerve block will contain normal saline, and the end-of-procedure intercostal nerve block will contain the local anesthetic.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative pain intensity during the first 24 hours following video-assisted thoracoscopic surgery (VATS) using the Visual Analog Scale (VAS)	Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), a patient-reported pain scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensity.	At 24 hours postoperatively
Postoperative pain intensity during the first hour following video-assisted thoracoscopic surgery (VATS) using the Visual Analog Scale (VAS)	Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), a patient-reported pain scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensity.	At 1 hour postoperatively
Postoperative pain intensity during the first 6 hours following video-assisted thoracoscopic surgery (VATS) using the Visual Analog Scale (VAS)	Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), a patient-reported pain scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensity.	At 6 hours postoperatively
Postoperative pain intensity during the first 12 hours following video-assisted thoracoscopic surgery (VATS) using the Visual Analog Scale (VAS)	Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), a patient-reported pain scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensity.	At 12 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative pain intensity during the first 48 hours following video-assisted thoracoscopic surgery (VATS) using the Visual Analog Scale (VAS)	Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), a patient-reported pain scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensit	At 48 hours postoperatively
Postoperative pain intensity during the first 72 hours following video-assisted thoracoscopic surgery (VATS) using the Visual Analog Scale (VAS)	Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), a patient-reported pain scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensit	At 72 hours postoperatively
incidence of chronic postoperative pain 3 months after video-assisted thoracoscopic surgery (VATS)	Chronic postoperative pain will be defined as pain developing after surgery and persisting for at least 3 months, not attributable to other causes and assessed by patient interview.	At 3 months after surgery
Intraoperative blood pressure stability	Variations in blood pressure during the procedure and need for vasopressors or corrective interventions. Blood pressure will be measured in mm Hg using an arterial catheter.	During video-assisted thoracic surgery
Intraoperative opioid consumption during video-assisted thoracoscopic surgery (VATS).	Intraoperative opioid consumption will be defined as the total cumulative dose of opioids administered between induction of anesthesia and the end of surgery. For remifentanil, consumption should be recorded as the total cumulative dose administered during the procedure.	From induction of anesthesia to the end of surgery
Incidence of postoperative complications during hospitalization.	Postoperative complications occurring during hospitalization will be recorded and categorized according to the Clavien-Dindo classification. Higher grades correspond to more severe postoperative complications.	During hospitalization, up to 30 days
Incidence of adverse effects and complications related to intercostal block administration.	Adverse effects and complications related to intercostal block administration occurring during surgery and hospitalization will be recorded.	From intercostal block administration until hospital discharge, up to 30 days

Collaborators and Investigators

• Sponsor: Erasme University Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): June 30, 2027
• Study Completion (Estimated): September 30, 2027

Study Registration Dates

• First Submitted: April 2, 2026
• First Submitted That Met QC Criteria: April 9, 2026
• First Posted (Actual): April 16, 2026

Study Record Updates

• Last Update Posted (Actual): April 16, 2026
• Last Update Submitted That Met QC Criteria: April 9, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Pain; VATS; Intercostal Nerve Block
• Additional Relevant MeSH Terms: Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain
• Other Study ID Numbers: P2026/145

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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