Serratus Posterior Superior Intercostal Plane Block Versus Intrathecal Morphine in VATS

Comparison of the Effects of Serratus Posterior Superior Intercostal Plane Block and Intrathecal Morphine on Postoperative Acute Pain in Patients Undergoing Video-assisted Thoracoscopic Surgery

This study aims to compare the analgesic effects of the serratus posterior superior intercostal plane block and intrathecal morphine in patients undergoing video-assisted thoracoscopic surgery.

This is a prospective, randomized, controlled, single-center clinical trial including adult patients undergoing elective thoracoscopic surgery. Participants will be randomly assigned to receive either a serratus posterior superior intercostal plane block or intrathecal morphine before general anesthesia.

The primary outcome is cumulative opioid consumption during the first 24 postoperative hours, expressed as intravenous morphine milligram equivalents. Secondary outcomes include pain scores, time to first analgesic request, quality of recovery, and postoperative complications.

The study aims to determine whether these two techniques differ in their effectiveness for postoperative pain management.

Study Overview

• Status: Recruiting
• Conditions: Postoperative Pain; Thoracic Anesthesia; Video Assisted Thoracic Surgery (VATS)
• Intervention / Treatment: Procedure: Serratus Posterior Superior Intercostal Plane Block; Procedure: Intrathecal Morphine

Detailed Description

This study is a prospective, randomized, controlled, single-blinded, parallel-group clinical trial designed to compare the analgesic efficacy of serratus posterior superior intercostal plane block and intrathecal morphine in patients undergoing video-assisted thoracoscopic surgery.

Eligible patients aged 18-75 years with American Society of Anesthesiologists physical status I-III scheduled for elective thoracoscopic procedures (wedge resection, segmentectomy, or lobectomy) will be included. Patients will be randomized in a 1:1 ratio using a computer-generated sequence with block randomization.

Participants in the serratus posterior superior intercostal plane block group will receive an ultrasound-guided regional block prior to the induction of general anesthesia. Participants in the intrathecal morphine group will receive an intrathecal morphine injection before general anesthesia. All patients will receive standardized general anesthesia and postoperative patient-controlled analgesia.

The primary outcome is cumulative opioid consumption within the first 24 postoperative hours, expressed as intravenous morphine milligram equivalents.

Secondary outcomes include opioid consumption at 12 hours, numeric rating scale pain scores at rest and during activity, time to first analgesic request, quality of recovery scores, postoperative nausea and vomiting, sedation levels, pruritus, respiratory depression, and postoperative complications up to 30 days.

This study aims to evaluate the relative effectiveness of these two analgesic techniques and to improve postoperative pain management strategies in thoracic surgery.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Cengiz Kaya, Prof Dr; Phone Number: +905056793359; Email: cengiz.kaya@omu.edu.tr

Study Locations

• Turkey (Türkiye)
  • Samsun
    • Atakent, Samsun, Turkey (Türkiye), 55270
      • Recruiting
      • Ondokuz Mayis University
      • Contact: Cengiz Kaya; Phone Number: 05056793359; Email: raufemre@yahoo.com

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 physical status I to III
• Scheduled for elective video-assisted thoracoscopic surgery, including wedge resection, segmentectomy, or lobectomy

Exclusion Criteria:

• Refusal to participate
• Pregnancy
• Morbid obesity (body mass index greater than 40 kg per square meter)
• Allergy to study medications
• Neuropsychiatric disorders, cognitive impairment, or inability to communicate
• History of substance abuse
• Active systemic infection or infection at the planned injection site
• Severe cardiac, respiratory, hepatic, renal, or endocrine disease.
• Chronic pain syndrome or ongoing chronic pain treatment
• Emergency surgery or previous ipsilateral VATS or thoracotomy
• Preoperative opioid use: ≥15 mg oral morphine equivalents/day for ≥30 days within the previous 3 months.
• Anticipated need for postoperative mechanical ventilation.
• Contraindications to neuraxial or peripheral regional anesthesia, including anticoagulant therapy, coagulopathy, infection, or relevant anatomical abnormalities.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Serratus Posterior Superior Intercostal Plane Block; Participants receive an ultrasound-guided serratus posterior superior intercostal plane block before induction of general anesthesia. A total of 30 milliliters of 0.25 percent bupivacaine with epinephrine is administered into the interfascial plane between the serratus posterior superior muscle and intercostal muscles. All patients subsequently undergo standardized general anesthesia and receive postoperative patient-controlled analgesia with intravenous morphine.	Procedure: Serratus Posterior Superior Intercostal Plane Block; Ultrasound-guided serratus posterior superior intercostal plane block is performed before induction of general anesthesia using 30 milliliters of 0.25 percent bupivacaine with epinephrine injected into the interfascial plane between the serratus posterior superior muscle and intercostal muscles.
Experimental: Intrathecal Morphine; Participants receive intrathecal morphine before induction of general anesthesia. Preservative-free morphine at 5 µg/kg based on ideal body weight is diluted with 0.9% saline to a total volume of 3 mL and administered intrathecally. All patients subsequently undergo standardized general anesthesia and receive postoperative patient-controlled analgesia with intravenous morphine.	Procedure: Intrathecal Morphine; Preservative-free morphine at 5 µg/kg based on ideal body weight is diluted with 0.9% saline to a total volume of 3 mL and administered intrathecally before induction of general anesthesia.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cumulative IV-MME during the first 24 hours after postoperative admission following extubation	Total opioid consumption during the first 24 postoperative hours is expressed as intravenous morphine milligram equivalents, including patient-controlled analgesia and rescue analgesia.	24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative pain scores	Pain intensity assessed using the 11-point Numeric Rating Scale (NRS; 0-10), where higher scores indicate greater pain intensity, with 0 representing no pain and 10 representing the worst imaginable pain, measured at rest and during activity.	0, 3, 6, 12, 18, and 24 hours postoperatively
Quality of recovery score	Quality of recovery assessed using the 15-item Quality of Recovery questionnaire (QoR-15; total score range 0-150), a validated patient-reported outcome measure where higher scores indicate better postoperative recovery.	Preoperative baseline, 24 hours postoperatively, and at discharge
Sedation level	Sedation level assessed using the Ramsay Sedation Scale (RSS; 1-6), a validated ordinal scale where higher scores indicate deeper sedation, with 1 representing anxiety/agitation and 6 representing no response to stimuli.	0, 3, 6, 12, 18, and 24 hours postoperatively
Respiratory depression	Incidence of respiratory depression defined as oxygen saturation below 90 percent or respiratory rate below 8 breaths per minute	24 hours
Pruritus	Incidence and severity of postoperative pruritus assessed using a 4-point ordinal scale (0-3), where 0 = no pruritus, 1 = mild pruritus (itching without scratching), 2 = moderate pruritus (itching with scratching), and 3 = severe pruritus requiring treatment; higher scores indicate worse symptoms.	0, 3, 6, 12, 18, and 24 hours postoperatively
Postoperative complications	Postoperative complications assessed using the Clavien-Dindo classification, where higher grades indicate more severe complications.	30 days
Remifentanil consumption	Total intraoperative remifentanil consumption administered during surgery, measured in micrograms (µg).	Intraoperative period (from induction to end of surgery), up to 4 hours
Rescue analgesia requirement	Incidence of patients requiring additional analgesia beyond patient-controlled analgesia	24 hours
Propofol consumption	Total intraoperative propofol consumption administered during surgery, measured in milligrams (mg).	Intraoperative period (from induction to end of surgery), up to 4 hours
Cumulative IV-MME during the first 12 hours after postoperative admission following extubation	Total opioid consumption during the first 12 postoperative hours expressed as intravenous morphine milligram equivalents	12 hours
Time to first patient-controlled analgesia demand	Time from postoperative admission to the first PCA morphine demand.	24 hours
Postoperative nausea and vomiting	Postoperative nausea and vomiting (PONV) will be assessed using a 4-point ordinal scale (0-3), where 0 indicates no nausea or vomiting, 1 indicates nausea without vomiting, 2 indicates a single episode of vomiting, and 3 indicates multiple episodes of vomiting; higher scores indicate worse symptoms. Scores >1 will be treated with ondansetron 4 mg IV; persistent symptoms will be treated with intravenous metoclopramide.	0, 3, 6, 12, 18, and 24 hours postoperatively
Block-related complications	Incidence of post-dural puncture headache, paresthesia, hematoma, and local anesthetic systemic toxicity associated with the study interventions.	Up to 30 days postoperatively
Incidence of postoperative nausea and/or vomiting	Incidence of postoperative nausea and vomiting (PONV), defined as the occurrence of at least one episode of nausea and/or vomiting within the first 24 hours postoperatively (yes/no). Patients experiencing at least one episode will be classified as having PONV.	24 hours postoperatively
Area under the numeric rating scale-time curve	The area under the numeric rating scale-time curve from 0 to 24 postoperative hours will be calculated separately for pain at rest and during activity using pain scores measured at 0, 3, 6, 12, 18, and 24 hours and the trapezoidal rule. Higher values indicate a greater cumulative pain burden.	0 to 24 hours postoperatively
Comprehensive Complication Index	Overall postoperative morbidity will be quantified using the Comprehensive Complication Index, which integrates all postoperative complications graded according to the Clavien-Dindo classification into a continuous score ranging from 0 to 100. Higher scores indicate greater overall morbidity.	Up to 30 days postoperatively

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Heart Rate	Heart rate measured intraoperatively and postoperatively, expressed in beats per minute (bpm).	Intraoperative period (up to 4 hours)
Mean Arterial Pressure	Mean arterial pressure measured intraoperatively and postoperatively, expressed in millimeters of mercury (mmHg).	Intraoperative period (up to 4 hours)

Collaborators and Investigators

• Sponsor: Ondokuz Mayıs University

Study record dates

Study Major Dates

• Study Start (Actual): April 15, 2026
• Primary Completion (Estimated): August 15, 2026
• Study Completion (Estimated): September 15, 2026

Study Registration Dates

• First Submitted: April 9, 2026
• First Submitted That Met QC Criteria: April 16, 2026
• First Posted (Actual): April 20, 2026

Study Record Updates

• Last Update Posted (Actual): August 10, 2026
• Last Update Submitted That Met QC Criteria: August 6, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: Nerve Block; Morphine; Thoracic Surgery, Video-Assisted; Injections, Spinal; Analgesia, Postoperative
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Nervous System Diseases; Postoperative Complications; Pathologic Processes; Neurobehavioral Manifestations; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Agnosia
• Other Study ID Numbers: SPSIPITM1

Drug and device information, study documents

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