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Two-Point Versus Single-Point Serratus Anterior Plane Block for Post-Thoracoscopic Surgery Analgesia

8. juli 2026 oppdatert av: Shiyou Wei

Comparison of Ultrasound-Guided Two-Point Combined vs Single-Point Serratus Anterior Plane Block for Postoperative Analgesia in Thoracoscopic Surgery: A Prospective Observational Cohort Study

Postoperative pain remains a common clinical challenge in patients undergoing video-assisted thoracoscopic surgery (VATS), impairing early recovery and increasing opioid consumption. The serratus anterior plane block (SAPB) is a widely used regional analgesic technique for thoracic surgery, but conventional single-point injection may have limited spread of local anesthetics, resulting in suboptimal analgesia in some patients. Preliminary anatomical evidence suggests that two-point combined SAPB may achieve wider dermatomal coverage and better analgesic efficacy.

This is a single-center, prospective observational cohort study conducted at Shanghai Pulmonary Hospital, China. A total of 88 adult patients scheduled for elective unilateral VATS will be consecutively enrolled and naturally assigned to either the two-point combined SAPB group (injection at the 3rd and 5th rib levels, total 30 ml local anesthetic) or the single-point SAPB group (injection at the 5th rib level, 30 ml local anesthetic) according to routine clinical practice.

The primary outcome is the verbal rating scale (VRS) pain score on coughing at 24 hours postoperatively. Secondary outcomes include resting and dynamic pain scores at multiple time points, cumulative opioid consumption at 24 and 48 hours, incidence of postoperative nausea and vomiting, block-related complications, length of hospital stay, and Quality of Recovery-15 (QoR-15) scores. This study aims to provide clinical evidence for optimizing perioperative analgesic strategies for thoracoscopic surgery.

Studieoversikt

Status

Har ikke rekruttert ennå

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

Study Background Video-assisted thoracoscopic surgery (VATS) is the standard minimally invasive approach for thoracic diseases, yet over 60% of patients experience moderate-to-severe postoperative pain within 24 hours, which impairs respiratory function, increases opioid consumption and prolongs hospital stay. The serratus anterior plane block (SAPB) is a widely used fascial plane block for thoracic analgesia, but conventional single-point injection often yields inconsistent anesthetic spread due to individual anatomical variations, resulting in suboptimal analgesia in some patients. Preliminary anatomical and clinical evidence suggests that two-point combined SAPB may achieve wider dermatomal coverage and superior analgesic efficacy, but confirmatory evidence in VATS patients remains limited.

Study Design & Population This is a single-center, prospective observational cohort study conducted at Shanghai Pulmonary Hospital, China. A total of 88 eligible patients aged 18-85 years with ASA physical status I-III, scheduled for elective unilateral VATS and planned for perioperative SAPB, will be consecutively enrolled. Patients will be naturally allocated to the two-point group or single-point group according to the clinical regimen chosen by the attending anesthesiologist, with no researcher-initiated randomization. Exclusion criteria include local infection at the puncture site, allergy to amide local anesthetics, chronic opioid use, severe coagulopathy, and cognitive impairment precluding pain assessment.

Interventions & Outcomes All blocks are performed under ultrasound guidance by anesthesiologists with ≥50 prior SAPB experiences. The two-point group receives 15 ml of local anesthetic at both the 3rd and 5th rib levels (total 30 ml); the single-point group receives 30 ml at the 5th rib level. Standardized general anesthesia and postoperative analgesia protocols are applied uniformly to all patients. The primary outcome is the verbal rating scale (VRS) pain score on coughing at 24 hours postoperatively. Secondary outcomes include resting and dynamic pain scores at multiple time points, cumulative opioid consumption at 24 and 48 hours, incidence of postoperative nausea and vomiting, block-related complications, length of hospital stay, and QoR-15 recovery quality scores.

Studietype

Observasjonsmessig

Registrering (Antatt)

88

Kontakter og plasseringer

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Studiekontakt

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

  • Voksen
  • Eldre voksen

Tar imot friske frivillige

N/A

Prøvetakingsmetode

Ikke-sannsynlighetsprøve

Studiepopulasjon

This single-center, prospective observational cohort study is conducted at Shanghai Pulmonary Hospital, Tongji University School of Medicine, China. It enrolls adults aged 18-85 years with ASA physical status I-III, scheduled for elective unilateral video-assisted thoracoscopic surgery and planned for ultrasound-guided serratus anterior plane block as routine perioperative analgesia.Eligible participants will be consecutively enrolled after written informed consent. Patients are naturally assigned to two cohorts based on the block regimen selected by the attending anesthesiologist in standard clinical practice, with a target total sample size of 88 (~44 per cohort). No study-initiated randomization or treatment intervention is applied; all clinical management follows institutional routine protocols.

Beskrivelse

Inclusion Criteria:

  • Aged 18 to 85 years at enrollment, regardless of sex
  • American Society of Anesthesiologists (ASA) physical status grade I to III
  • Scheduled for elective unilateral video-assisted thoracoscopic surgery
  • Planned to receive ultrasound-guided SAPB for routine perioperative analgesia
  • Able to understand study procedures and provide written informed consent

Exclusion Criteria:

  • Local infection or skin lesion at the block puncture site
  • Known hypersensitivity or allergy to amide local anesthetics
  • Preexisting sensory abnormality in the chest wall surgical area
  • Chronic opioid use for > 3 months, history of chronic pain syndrome, or history of opioid abuse
  • Severe coagulopathy (international normalized ratio > 1.5 or platelet count < 80 × 10⁹/L)
  • Cognitive impairment or inability to cooperate with postoperative pain assessment
  • Refusal to provide written informed consent

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

Kohorter og intervensjoner

Gruppe / Kohort
Intervensjon / Behandling
Two-Point SAPB Group
Patients in this cohort receive ultrasound-guided two-point combined serratus anterior plane block for perioperative analgesia as part of routine clinical practice. A total of 30 mL local anesthetic is administered, with 15 mL injected deep to the serratus anterior muscle at the 3rd rib level and 15 mL at the 5th rib level.
Fremgangsmåte: Two-Point Serratus Anterior Plane Block
Ultrasound-guided fascial plane block for perioperative thoracic analgesia. Local anesthetic is deposited deep to the serratus anterior muscle at two separate rib levels, with equal volume split between the 3rd and 5th intercostal spaces.
Andre navn:
  • Two-Point SAPB; Double-Point Serratus Plane Block
Single-Point SAPB Group
Patients in this cohort receive ultrasound-guided single-point serratus anterior plane block for perioperative analgesia as part of routine clinical practice. A total of 30 mL local anesthetic is injected deep to the serratus anterior muscle at the 5th rib level in a single administration.
Fremgangsmåte: Single-Point Serratus Anterior Plane Block
Ultrasound-guided fascial plane block for perioperative thoracic analgesia. A single bolus of local anesthetic is deposited deep to the serratus anterior muscle at the 5th intercostal level.
Andre navn:
  • ingle-Point SAPB; Conventional Serratus Plane Block

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Verbal Rating Scale (VRS) Pain Score on Coughing at 24 Hours Postoperatively
Tidsramme: 24 hours after surgery
Dynamic pain intensity assessed using a 0-10 verbal rating scale (0 = no pain, 10 = worst imaginable pain) when the patient performs coughing.
24 hours after surgery

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Resting Verbal Rating Scale (VRS) Pain Scores
Tidsramme: 1 hour, 6 hours, 12 hours, 24 hours, 48 hours after surgery
Resting pain measured using a 0-10 verbal rating scale at multiple postoperative time points.
1 hour, 6 hours, 12 hours, 24 hours, 48 hours after surgery
Cumulative Postoperative Opioid Consumption
Tidsramme: 24 hours and 48 hours after surgery
Total opioid consumption after surgery, converted to standard intravenous morphine equivalents.
24 hours and 48 hours after surgery
Incidence of Postoperative Nausea and Vomiting (PONV)
Tidsramme: Within 48 hours after surgery
Proportion of patients experiencing nausea and/or vomiting within 48 hours after surgery.
Within 48 hours after surgery
Incidence of Block-Related Adverse Events
Tidsramme: Within 48 hours after surgery
Proportion of patients with block-related complications, including pneumothorax, local hematoma, and local anesthetic toxicity.
Within 48 hours after surgery
Quality of Recovery-15 (QoR-15) Score
Tidsramme: 24 hours and 48 hours after surgery
Patient-reported postoperative recovery quality assessed by the 15-item Quality of Recovery scale (total score range 0-150; higher score indicates better recovery quality).
24 hours and 48 hours after surgery

Samarbeidspartnere og etterforskere

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Sponsor

Shiyou Wei

Etterforskere

  • Hovedetterforsker: Shiyou Wei, Tongji University Affiliated Shanghai Pulmonary Hospital

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Antatt)

1. august 2026

Primær fullføring (Antatt)

1. september 2026

Studiet fullført (Antatt)

5. september 2026

Datoer for studieregistrering

Først innsendt

8. juli 2026

Først innsendt som oppfylte QC-kriteriene

8. juli 2026

Først lagt ut (Faktiske)

14. juli 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

14. juli 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

8. juli 2026

Sist bekreftet

1. juli 2026

Mer informasjon

Begreper knyttet til denne studien

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • 2026LY0735

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