SPSIP Block vs SAP Block for Post-VATS Pain

Official title

Comparison of Serratus Posterior Superior Intercostal Plane Block and Serratus Anterior Plane Block for Pain Management Following Video-Assisted Thoracoscopic Surgery

Overview

Comparison of Superior Serratus Posterior Intercostal Plane Block and Serratus Anterior Plane Block for Pain Management Following Video-Assisted Thoracoscopic Surgery: A Randomized Prospective 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, there is no randomized controlled trial directly comparing it with SPSIPB. Therefore, this planned study aimed to evaluate whether SPSIPB is noninferior to SAPB for postoperative analgesia and to compare the postoperative analgesic efficacy of the two techniques performed under ultrasound guidance.

Interventions

• Procedure 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-pla
• Procedure 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. Hydrodissec

Primary outcome measures

• To determine the effectiveness of ultrasound-guided SPSIP block versus SAP block after VATS using postoperative NRS pain scores. [Time frame: NRS scores will be assessed at 1, 6, 12, 18, and 24 hours postoperatively.]

Secondary outcome measures (4)

• QoR-15 recovery score [Time frame: up to 48 hours]
• time to first rescue analgesia [Time frame: up to 48 hours]
• The total amount of rescue analgesic consumption [Time frame: up to 24 hours]
• the incidence of block-related complications. [Time frame: up to 48 hours]

Eligibility criteria

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.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Triple blind

Primary purpose

Prevention

Study locations

Turkey (Türkiye) · 1 center

• Fırat University Faculty of Medicine Hospital — Elâzığ

Identifiers

NCT: NCT07467291 · 43757

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗