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Bloqueio SPSIP vs Bloqueio SAP para Dor Pós-VATS

29 de setembro de 2026 atualizado por: AHMET AKSU, Firat University

Comparação do Bloqueio do Plano Intercostal do Serrátil Póstero-Superior e do Bloqueio do Plano do Serrátil Anterior para o Controlo da Dor após Cirurgia Toracoscópica Assistida por Vídeo

Comparison of Superior Serratus Posterior Intercostal Plane Block and Serratus Anterior Plane Block for Pain Management Following Video-Assisted Thoracoscopic Surgery: A Prospective Observational Cohort Study

Introduction Video-assisted thoracoscopic surgery (VATS) is associated with lower postoperative pain, shorter hospital stays, and better preservation of pulmonary function compared with conventional thoracotomy, owing to its minimally invasive nature. Although VATS was initially performed using a multi-port technique, it has evolved into a single-port approach, reflecting advances in surgical techniques and equipment. In Uniportal VATS, limiting surgical trauma to a single intercostal space may reduce the risk of chronic postoperative pain by decreasing intercostal nerve damage.

Because inadequate pain control after VATS may predispose patients to developing chronic post-thoracotomy pain syndrome (PTPS), effective postoperative analgesia is critically important. Therefore, regional analgesic techniques are recommended as part of multimodal analgesia. PROSPECT guidelines do not recommend the routine use of thoracic epidural analgesia for VATS, despite its effectiveness, because of its invasiveness; instead, they emphasize peripheral blocks such as paravertebral block and erector spinae plane block.

Although not included among first-line analgesic interventions in PROSPECT guidelines, the serratus anterior plane block (SAPB) is a widely used and well-established technique in thoracic surgery. In addition, the superior serratus posterior intercostal plane block (SPSIPB) is gaining attention in VATS surgery because of its analgesic effect covering the C3-T10 dermatomes.

Although there are studies in the literature comparing SAPB with different regional techniques, direct comparisons with SPSIPB are limited. Therefore, this prospective observational cohort study aimed to compare postoperative analgesic outcomes in patients undergoing uniportal VATS who received either ultrasound-guided SPSIPB or SAPB, with the block type selected by the attending anesthesiologist as part of routine clinical care.

Visão geral do estudo

Status

Concluído

Condições

Intervenção / Tratamento

Descrição detalhada

This single-center prospective observational cohort study included adult patients undergoing elective uniportal VATS who received an ultrasound-guided serratus anterior plane block (SAPB) or serratus posterior superior intercostal plane block (SPSIPB) for postoperative analgesia. Patients were not randomized; the block type was selected by the attending anesthesiologist as part of routine clinical care. All blocks were performed with 30 mL of 0.25% bupivacaine at the end of surgery. Postoperative pain scores and rescue analgesic use were recorded in routine observation forms by recovery unit and ward nurses who were not informed of the block type. Postoperative analgesia followed a standard multimodal protocol, with 50 mg intravenous tramadol given as rescue analgesia when the resting NRS score was 4 or higher.

Tipo de estudo

Observacional

Inscrição (Real)

80

Contactos e Locais

Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.

Locais de estudo

  • Turquia (Türkiye)
      • Elâzığ, Turquia (Türkiye), 23100
        • Fırat University Faculty of Medicine Hospital

Critérios de participação

Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.

Critérios de elegibilidade

Idades elegíveis para estudo

18 anos a 65 anos (Adulto, Adulto mais velho)

Aceita Voluntários Saudáveis

Não

Gêneros Elegíveis para o Estudo

Tudo

Método de amostragem

Amostra Não Probabilística

População do estudo

Adult patients undergoing elective uniportal video-assisted thoracoscopic surgery at Firat University Hospital who received either a serratus anterior plane block or a serratus posterior superior intercostal plane block for postoperative analgesia as part of routine care.

Descrição

Inclusion Criteria:

  • aged 18-65 years,
  • with American Society of Anesthesiologists (ASA) physical status classification I-III,
  • Body Mass Index (BMI) < 35 kg/m²,
  • and who read and signed the informed consent form were included.

Exclusion Criteria:

  • inability to communicate in Turkish, refusal to consent,
  • inability to use the numerical pain rating scale (NRS),
  • allergy to local anesthetics or study-specific analgesics;
  • pregnancy or breastfeeding;
  • uncontrolled anxiety or substance dependence;
  • history of thoracic surgery,
  • trauma,
  • neuromuscular or peripheral nerve disorders;
  • diabetes mellitus,
  • hepatic or renal insufficiency,
  • coagulation disorders;
  • chronic opioid or steroid use;
  • widespread pain;
  • anticoagulant therapy;
  • infection at the block application site;
  • early termination of surgery;
  • absence of planned postoperative extubation.

Plano de estudo

Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.

Como o estudo é projetado?

Detalhes do projeto

  • Modelos de observação: COHORT
  • Perspectivas de Tempo: PROSPECTIVE

Coortes e Intervenções

Grupo / Coorte
Intervenção / Tratamento
Serratus posterior superior intercostal plane block Group

Patients who received an ultrasound-guided serratus posterior superior intercostal plane block (30 mL of 0.25% bupivacaine) at the end of uniportal VATS for postoperative analgesia. The block type was selected by the attending anesthesiologist as part of routine clinical care; patients were not randomized.
Procedimento: Serratus posterior superior intercostal plane block

The procedure was performed with the patient in the lateral decubitus position. After a slight lateral displacement of the scapula, the scapular spine was visualized with ultrasound, and the probe was moved medially. After locating the tip of the scapular spine, the probe was placed sagittally at the superior angle of the scapula, and the third rib was visualized. The block needle was advanced craniocaudally and placed between the posterior superior serratus muscle and the third rib. Hydrodissection was performed with an injection of 2 mL of saline to confirm block needle placement. After confirming the block site, 30 mL of 0.25% bupivacaine was injected.
Serratus Anterior Plane Block (SAPB) group

Patients who received an ultrasound-guided serratus anterior plane block (30 mL of 0.25% bupivacaine) at the end of uniportal VATS for postoperative analgesia. The block type was selected by the attending anesthesiologist as part of routine clinical care; patients were not randomized.
Procedimento: Serratus Anterior Plane Block (SAPB) group

The block was performed with the patient in the lateral decubitus position. Ultrasound-guided SAPB was performed by the same anesthesiologist with over three years of experience in ultrasound-guided regional anesthesia, using a high-frequency linear probe (LOGIQ e Ultrasound, GE HealthCare, United States). The probe was positioned parallel to the mid-axillary line, and the ribs were readily identified as hyperechogenic lines. The fifth rib was identified in the mid-axillary line. Using an in-plane technique, the needle was placed in the myofascial plane between the serratus anterior muscle and the fifth rib, and 30 mL of 0.25% bupivacaine was injected.

O que o estudo está medindo?

Medidas de resultados primários

Medida de resultado
Descrição da medida
Prazo
To determine the effectiveness of ultrasound-guided SPSIP block versus SAP block after VATS using postoperative NRS pain scores.
Prazo: NRS scores will be assessed upon admission to the post-anesthesia care unit (0 min), at 30 minutes, and at 1, 6, 12, 18, and 24 hours postoperatively.

The NRS score is based on the patient rating their pain on a scale from 0 to 10. Zero indicates no pain, while 10 indicates the most severe pain possible.
NRS scores will be assessed upon admission to the post-anesthesia care unit (0 min), at 30 minutes, and at 1, 6, 12, 18, and 24 hours postoperatively.

Medidas de resultados secundários

Medida de resultado
Descrição da medida
Prazo
QoR-15 recovery score
Prazo: up to 48 hours

The QoR-15 (Quality of Recovery-15) scale is a patient-reported outcome questionnaire used to evaluate the quality of postoperative recovery. The QoR-15 consists of 15 items assessing five domains: pain, physical comfort, physical independence, psychological support, and emotional state. The total score ranges from 0 to 150, with higher scores indicating a better quality of recovery.
up to 48 hours
Time to first rescue analgesia
Prazo: up to 24 hours

The time to first rescue analgesia, defined as the time interval between recovery from anesthesia and the first administration of rescue analgesia (50 mg intravenous tramadol for NRS ≥4), was recorded and expressed in hours.
up to 24 hours
The total amount of rescue analgesic consumption
Prazo: up to 24 hours

The total amount of rescue analgesic consumption within the first 24 postoperative hours (mg) was also documented.
up to 24 hours
The incidence of block-related complications.
Prazo: up to 48 hours

block-related complications such as hematoma, paralysis, hypotension or other adverse events were recorded.
up to 48 hours

Colaboradores e Investigadores

É aqui que você encontrará pessoas e organizações envolvidas com este estudo.

Patrocinador

Firat University

Investigadores

  • Investigador principal: Ahmet Aksu, MD, Firat University

Datas de registro do estudo

Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados ​​pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.

Datas Principais do Estudo

Início do estudo (Real)

13 de março de 2026

Conclusão Primária (Real)

1 de agosto de 2026

Conclusão do estudo (Real)

1 de agosto de 2026

Datas de inscrição no estudo

Enviado pela primeira vez

6 de fevereiro de 2026

Enviado pela primeira vez que atendeu aos critérios de CQ

11 de março de 2026

Primeira postagem (Real)

12 de março de 2026

Atualizações de registro de estudo

Última Atualização Postada (Real)

2 de outubro de 2026

Última atualização enviada que atendeu aos critérios de controle de qualidade

29 de setembro de 2026

Última verificação

1 de setembro de 2026

Mais Informações

Termos relacionados a este estudo

Palavras-chave

Termos MeSH relevantes adicionais

Outros números de identificação do estudo

  • 43757

Plano para dados de participantes individuais (IPD)

Planeja compartilhar dados de participantes individuais (IPD)?

NÃO

Informações sobre medicamentos e dispositivos, documentos de estudo

Estuda um medicamento regulamentado pela FDA dos EUA

Não

Estuda um produto de dispositivo regulamentado pela FDA dos EUA

Não

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