SPSIP Versus RISS Block in Volume-Preserving VATS (SRVATS)

Comparison of Serratus Posterior Superior Intercostal Plane Block and Rhomboid Intercostal-Subserratus Plane Block on Postoperative Analgesia and Respiratory Functions in Volume-Preserving Video-Assisted Thoracoscopic Surgery: A Prospective Randomized Controlled Trial

This prospective randomized controlled study aims to compare the effects of Serratus Posterior Superior Intercostal Plane (SPSIP) block and Rhomboid Intercostal and Subserratus (RISS) block on postoperative pain, respiratory function, and recovery quality in patients undergoing volume-preserving video-assisted thoracoscopic surgery (VATS). Eighty-four patients will be randomized in a 1:1 ratio to receive either SPSIP block or RISS block. The primary outcome is the incidence of somatic pain at the chest drain insertion site at postoperative 2 hours. Secondary outcomes include pain scores, opioid consumption, quality of recovery, diaphragmatic function, pulmonary function, rescue analgesic requirements, postoperative nausea and vomiting, and block-related complications.

Study Overview

• Status: Not yet recruiting
• Conditions: Postoperative Pain; Thoracic Surgery
• Intervention / Treatment: Procedure: Serratus posterior superior intercostal plane block; Procedure: Rhomboid Intercostal and Subserratus Block

Detailed Description

Video-assisted thoracoscopic surgery (VATS) is associated with significant postoperative pain that may impair respiratory function and delay recovery. Regional anesthesia techniques are increasingly used to improve analgesia while minimizing opioid-related adverse effects.

The Serratus Posterior Superior Intercostal Plane (SPSIP) block and the Rhomboid Intercostal and Subserratus (RISS) block are novel ultrasound-guided fascial plane blocks that provide thoracic analgesia through different mechanisms. However, comparative clinical evidence regarding their efficacy in VATS patients remains limited.

This prospective, randomized, controlled study will enroll 84 adult patients scheduled for volume-preserving VATS. Participants will be randomly assigned to receive either SPSIP block or RISS block in a 1:1 ratio (42 patients per group).

The primary endpoint is the incidence of somatic pain at the chest drain insertion site at postoperative 2 hours.

Secondary endpoints include postoperative pain scores at rest and during movement, total intravenous morphine consumption during the first 24 postoperative hours, Quality of Recovery-15 (QoR-15) score at postoperative 24 hours, diaphragmatic excursion measured by ultrasonography, peak expiratory flow measurements, rescue analgesic requirements, time to first rescue analgesia, incidence of postoperative nausea and vomiting, and block-related complications.

The study has been approved by the Bursa Sehir Hospital Clinical Research Ethics Committee and will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice principles.

• Study Type: Interventional
• Enrollment (Estimated): 84
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yusuf Alan; Phone Number: +905396210977; Email: dryusufalan@gmail.com

Study Locations

• Turkey (Türkiye)
  • Nilüfer
    • Bursa, Nilüfer, Turkey (Türkiye), 16100
      • Bursa City Hospital
      • Contact: Yusuf Alan, MD; Phone Number: 05396210977; Email: dryusufalan@gmail.com
      • Principal Investigator: Yusuf Alan, MD
      • Sub-Investigator: Onur Gunes, MD
      • Sub-Investigator: Halil ERTEK, MD

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Patients scheduled for elective biportal video-assisted thoracoscopic surgery (VATS) with lung parenchyma-preserving thoracic procedures under general anesthesia
• American Society of Anesthesiologists (ASA) physical status I-III
• Age between 18 and 75 years
• Provision of written informed consent

Exclusion Criteria:

• Use of anticoagulant or antiplatelet therapy
• Bleeding diathesis
• Known allergy to local anesthetics
• Infection at the planned block site
• Severe chronic pulmonary disease or advanced respiratory failure (e.g., severe COPD or restrictive lung disease)
• Cognitive impairment preventing reliable NRS assessment
• Pregnancy or lactation
• Chronic opioid use (regular use for ≥3 months)
• Severe hepatic or renal failure
• Refusal to participate
• Technical failure or unsuccessful regional block
• Conversion to open thoracotomy during surgery

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: SPSIP Block Group; Patients will receive an ultrasound-guided Serratus Posterior Superior Intercostal Plane (SPSIP) block before induction of general anesthesia for postoperative analgesia after video-assisted thoracic surgery (VATS).	Procedure: Serratus posterior superior intercostal plane block; Ultrasound-guided Serratus Posterior Superior Intercostal Plane (SPSIP) block performed before induction of general anesthesia using local anesthetic for postoperative analgesia in patients undergoing video-assisted thoracic surgery.
Experimental: RISS Block Group; Patients will receive an ultrasound-guided Rhomboid Intercostal and Subserratus (RISS) block before induction of general anesthesia for postoperative analgesia after video-assisted thoracic surgery (VATS).	Procedure: Rhomboid Intercostal and Subserratus Block; Ultrasound-guided Rhomboid Intercostal and Subserratus (RISS) block performed before induction of general anesthesia using local anesthetic for postoperative analgesia in patients undergoing video-assisted thoracic surgery.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of Somatic Pain at Chest Tube Insertion Site	Incidence of somatic pain localized at the chest tube insertion site, defined as sharp localized pain aggravated by coughing or deep inspiration, recorded as present or absent.	Postoperative 2 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative Pain Scores at Rest	Static postoperative pain scores assessed using the Numeric Rating Scale (NRS) at rest.	Postoperative 2, 6, 12, and 24 hours
Postoperative Pain Scores During Movement	Dynamic postoperative pain scores assessed using the Numeric Rating Scale (NRS) during movement.	Postoperative 2, 6, 12, and 24 hours
Total Intravenous Morphine Consumption	Total intravenous morphine consumption during the first 24 hours after surgery.	Postoperative 24 hours
Interval Intravenous Morphine Consumption	Intravenous morphine consumption recorded separately for postoperative 0-8, 8-16, and 16-24 hour intervals.	Postoperative 0-8, 8-16, and 16-24 hours
Right Hemidiaphragm Excursion	Right hemidiaphragm excursion measured by ultrasonography to evaluate diaphragmatic function.	Preoperative and postoperative 6 hours
Peak Expiratory Flow	Peak expiratory flow measured using a peak flowmeter to evaluate respiratory performance.	Preoperative and postoperative 6 hours
Quality of Recovery-15 Score	Postoperative recovery quality assessed using the Quality of Recovery-15 (QoR-15) questionnaire.	Postoperative 24 hours

Collaborators and Investigators

• Sponsor: Ferit Yetik
• Collaborators: Bursa Sehir Hastanesi

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: June 12, 2026
• First Submitted That Met QC Criteria: June 12, 2026
• First Posted (Actual): June 17, 2026

Study Record Updates

• Last Update Posted (Actual): June 17, 2026
• Last Update Submitted That Met QC Criteria: June 12, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: VATS; Diaphragmatic Excursion; Video-Assisted Thoracic Surgery; Peak Expiratory Flow; Serratus Posterior Superior Intercostal Plane Block; Rhomboid Intercostal and Subserratus Block
• 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: 26-AKD-150; 2025-KAEK-47 (Other Identifier: Bursa City Hospital Clinical Research Ethics Committee)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Individual participant data (IPD) sharing has not yet been determined. The decision regarding data sharing will be made after study completion and in accordance with institutional policies, ethical considerations, and participant confidentiality requirements.

Drug and device information, study documents

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