Comparison of the Rhomboid Intercostal Block and Serratus Posterior Superior Intercostal Plane Block

Comparison of the Effects of Ultrasound-Guided Rhomboid Intercostal Block and Serratus Posterior Superior Intercostal Plane Block on Postoperative Acute Pain in Patients Undergoing Video-Assisted Thoracoscopic Surgery

Video-assisted thoracic surgery (VATS) is widely performed for the management of various thoracic pathologies and is generally associated with reduced surgical trauma compared with open thoracotomy. Nevertheless, patients may still experience considerable postoperative pain, which can adversely affect respiratory function, mobilization, and recovery. Various regional analgesic techniques have been incorporated into multimodal pain management strategies for VATS, including thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), intercostal nerve block, serratus anterior plane block (SAPB), rhomboid intercostal block (RIB), and serratus posterior superior intercostal plane block (SPSIPB). Among these approaches, ultrasound-guided TPVB has traditionally been regarded as a reference regional analgesic technique. More recently, interfascial plane blocks have gained increasing attention because of their technical simplicity and favorable safety profile. RIB and SPSIPB are two novel interfascial plane blocks that may provide effective postoperative analgesia following thoracic surgery. The present study aims to compare the analgesic efficacy of RIB and SPSIPB in patients undergoing VATS and to evaluate their impact on postoperative pain outcomes.

Study Overview

• Status: Recruiting
• Conditions: Pain, Postoperative; Thoracic Surgery, Video-Assisted; Multimodal Analgesia; Rhomboid Intercostal Block; Serratus Posterior Superior Intercostal Plane Block
• Intervention / Treatment: Drug: Rhomboid Intercostal Block; Drug: Serratus Posterior Superior Intercostal Plane Block

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

Contacts and Locations

• Study Contact: Name: Emine Nilgün Zengin, Associate Professor; Phone Number: 00905063370548; Email: nilbavullu@gmail.com
• Study Contact Backup: Name: Hülya Yiğit, Associate Professor; Phone Number: 00905054853939; Email: yigitozay@hotmail.com

Study Locations

• Turkey (Türkiye)
  • Ankara
    • Çankaya, Ankara, Turkey (Türkiye), 06290
      • Recruiting
      • Ankara City Hospital
      • Contact: Emine N Zengin, MD; Phone Number: +905063370548; Email: nilbavullu@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Patients undergoing elective VATS
• Patients aged 18-75 years
• Patients with ASA (American Society of Anesthesiologists) class I-III
• Patients who have given informed consent

Exclusion Criteria:

• Patients allergic to local anesthetics
• Patients with bleeding disorders or those undergoing anticoagulant therapy
• Pregnant and breastfeeding women
• Patients with impaired consciousness, inability to communicate, or mental/cognitive impairment
• Patients who refuse block application
• Patients with infection in the area where the block will be applied

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: Rhomboid Intercostal Block; For patients scheduled to receive a Rhomboid Intercostal Block (RIB), after sonographic identification of the relevant anatomical structures, the block needle is advanced using an in-plane ultrasound-guided technique beneath the rhomboid muscle until contact with the rib is achieved. Following hydrodissection with 2 mL of normal saline to confirm correct needle placement, 30 mL of 0.25% bupivacaine is injected into the interfascial plane.	Drug: Rhomboid Intercostal Block; Rhomboid intercostal block will be applied to the patients under real-time ultrasound guidance.
Active Comparator: Serratus Posterior Superior Intercostal Plane Block; For patients scheduled to receive a Serratus Posterior Superior Intercostal Plane Block (SPSIPB), after sonographic identification of the relevant anatomical structures, the block needle is advanced using an in-plane ultrasound-guided technique beneath the serratus posterior superior muscle until contact with the rib is achieved. Following hydrodissection with 2 mL of normal saline to confirm correct needle placement, 30 mL of 0.25% bupivacaine is injected into the interfascial plane.	Drug: Serratus Posterior Superior Intercostal Plane Block; Serratus posterior superior intercostal plane block will be applied to the patients under real-time ultrasound guidance.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Surgical Pain Scores	Surgical pain will be assessed at rest and while coughing using the visual analog scale on a scale from 0mm (no pain) to 100mm (worst pain). Pain assessment will be done at 1st, 6th, 12th, and 24th hours after surgery.	24 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intraoperative remifentanil consumption	The amount of remifentanil that patients need to maintain anesthesia during the intraoperative period will be recorded.	During the intraoperative period
Shoulder Pain Scores	Shoulder pain will be assessed at rest and while coughing using the visual analog scale on a scale from 0mm (no pain) to 100mm (worst pain). Pain assessment will be done at 1st, 6th, 12th, and 24th hours after surgery.	24 hours after surgery

Collaborators and Investigators

• Sponsor: Ankara City Hospital Bilkent

Study record dates

Study Major Dates

• Study Start (Actual): June 15, 2026
• Primary Completion (Estimated): November 20, 2026
• Study Completion (Estimated): November 30, 2026

Study Registration Dates

• First Submitted: June 11, 2026
• First Submitted That Met QC Criteria: June 15, 2026
• First Posted (Actual): June 16, 2026

Study Record Updates

• Last Update Posted (Actual): June 16, 2026
• Last Update Submitted That Met QC Criteria: June 15, 2026
• Last Verified: June 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
• Other Study ID Numbers: E.Kurul-E2-26-14830

Drug and device information, study documents

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