Pain Control and Recovery After Thoracic Surgery Using SPSIP Block

Adult patients undergoing elective minor video-assisted thoracoscopic surgery (VATS) under general anesthesia who receive an ultrasound-guided Serratus Posterior Superior Intercostal Plane (SPSIP) block as part of routine institutional multimodal analgesia. The surgical procedure and regional analgesic technique are determined as part of routine clinical care and are not assigned by the study protocol.

An ultrasound-guided Serratus Posterior Superior Intercostal Plane (SPSIP) block will be performed after induction of general anesthesia according to routine institutional clinical practice using a long-acting local anesthetic.

Adult patients undergoing elective major video-assisted thoracoscopic surgery (VATS) under general anesthesia who receive an ultrasound-guided Serratus Posterior Superior Intercostal Plane (SPSIP) block as part of routine institutional multimodal analgesia. The surgical procedure and regional analgesic technique are determined as part of routine clinical care and are not assigned by the study protocol.

An ultrasound-guided Serratus Posterior Superior Intercostal Plane (SPSIP) block will be performed after induction of general anesthesia according to routine institutional clinical practice using a long-acting local anesthetic.

Adult patients undergoing elective thoracotomy under general anesthesia who receive an ultrasound-guided Serratus Posterior Superior Intercostal Plane (SPSIP) block as part of routine institutional multimodal analgesia. The surgical procedure and regional analgesic technique are determined as part of routine clinical care and are not assigned by the study protocol.

An ultrasound-guided Serratus Posterior Superior Intercostal Plane (SPSIP) block will be performed after induction of general anesthesia according to routine institutional clinical practice using a long-acting local anesthetic.

Postoperative quality of recovery will be assessed using the 15-item Quality of Recovery questionnaire (QoR-15). Higher scores indicate better postoperative recovery. QoR-15 scores will be compared among the minor VATS, major VATS, and thoracotomy cohorts.

Total opioid consumption during the first 24 hours after surgery will be calculated and converted to morphine milligram equivalents (MME) to allow comparison among the three surgical cohorts.

Postoperative pain intensity at rest will be assessed using the 11-point Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity and therefore a worse outcome.

Postoperative pain intensity at rest will be assessed using the 11-point Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity and therefore a worse outcome.

Postoperative pain intensity at rest will be assessed using the 11-point Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity and therefore a worse outcome.

Postoperative pain intensity at rest will be assessed using the 11-point Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity and therefore a worse outcome.

Postoperative pain intensity at rest will be assessed using the 11-point Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity and therefore a worse outcome.

Postoperative pain intensity during coughing will be assessed using the 11-point Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity and therefore a worse outcome.

Postoperative pain intensity during coughing will be assessed using the 11-point Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity and therefore a worse outcome.

Postoperative pain intensity during coughing will be assessed using the 11-point Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity and therefore a worse outcome.

Postoperative pain intensity during coughing will be assessed using the 11-point Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity and therefore a worse outcome.

Postoperative pain intensity during coughing will be assessed using the 11-point Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity and therefore a worse outcome.

Time from completion of surgery to the first administration of rescue analgesic medication will be recorded.

The total amount of rescue analgesic medication administered during the postoperative observation period will be recorded.

The number of participants experiencing postoperative nausea and/or vomiting will be recorded.

The number of participants requiring rescue antiemetic medication will be recorded.

Time from the end of surgery to the patient's first postoperative ambulation will be recorded in hours. First ambulation will be defined as the first documented occasion on which the patient gets out of bed and ambulates with or without assistance. Patients who do not ambulate before hospital discharge will be considered not to have experienced the event during the observation period.

The duration of postoperative hospitalization will be recorded in days, calculated from the end of surgery until hospital discharge.

Chronic postsurgical pain will be defined as pain that developed or increased in intensity after surgery, is located in the surgical area or a related innervation territory, persists at 3 months after surgery, and is not better explained by infection, malignancy, a pre-existing pain condition, or another alternative cause. Pain intensity will be assessed using an 11-point Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain).

Chronic postsurgical pain will be defined as pain that developed or increased in intensity after surgery, is located in the surgical area or a related innervation territory, persists at 6 months after surgery, and is not better explained by infection, malignancy, a pre-existing pain condition, or another alternative cause. Pain intensity will be assessed using an 11-point Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain).

The number of participants requiring unplanned hospital readmission within 30 days after surgery will be recorded.

The number of participants who develop one or more complications related to the Serratus Posterior Superior Intercostal Plane (SPSIP) block will be recorded. Complications will include local anesthetic systemic toxicity, pneumothorax attributable to the block, hematoma at the block site, and infection at the block site.

Postoperative pulmonary complications will include pneumonia, clinically significant atelectasis requiring therapeutic intervention, bronchospasm requiring treatment, aspiration pneumonitis, acute respiratory distress syndrome, postoperative respiratory failure requiring non-invasive ventilatory support or reintubation, or an unplanned escalation in respiratory support. Participants experiencing at least one of these events will be considered to have a postoperative pulmonary complication.

Patient satisfaction with postoperative pain management will be assessed using a 5-point Likert scale: 1 = very dissatisfied, 2 = dissatisfied, 3 = neither satisfied nor dissatisfied, 4 = satisfied, and 5 = very satisfied. Higher scores indicate greater satisfaction with postoperative analgesia.