Postoperative Analgesia, Video Assisted Thoracoscopic Surgery
Conditions
Keywords
serratus posterior superior intercostal plane block, Video-assisted thoracoscopic surgery, serratus anterior plane block
Brief summary
Thoracotomy is known as one of the most painful surgical procedures, with up to 65% of patients developing chronic post-thoracotomy pain syndrome (PTPS), and approximately 10% experiencing pain that significantly impacts quality of life. Video-assisted thoracoscopic surgery (VATS) has become increasingly common over the past decade and offers reduced postoperative pain, morbidity, and length of hospital stay compared to open thoracotomy. However, VATS can still cause moderate to severe postoperative pain and a high risk of chronic pain. Optimizing analgesia after VATS remains critical. With advances in ultrasound technology, several regional anesthesia techniques such as serratus anterior plane block (SAPB), erector spinae plane block (ESPB), and thoracic epidural analgesia (TEA) have shown comparable efficacy. In 2023, Tulgar et al. described the serratus posterior superior intercostal plane block (SPSIPB), which demonstrated dermatomal coverage from C3 to T10. This randomized controlled trial aims to compare the analgesic efficacy of SPSIPB and SAPB in patients undergoing VATS procedures.
Detailed description
The patients will be divided into two groups and all will receive general anesthesia. Before extubation, one group will receive a Serratus Anterior Plane Block, and the other group will receive a Serratus Posterior Superior Intercostal Plane Block. The randomization of the study will be performed by a physician who will not be involved in the patient follow-up, using a computer-generated randomization code (generated by the computer). The interfascial plane block (Serratus Anterior Plane Block or Serratus Posterior Superior Intercostal Plane Block) will be given to the anesthesiologist in a sealed envelope by an independent assistant personnel outside the study. The patient will not be aware of which block is being applied. The anesthesiologist performing the block will not participate in the patients' pain monitoring. Postoperative pain assessment and data collection will be performed by another anesthesiologist who is unaware of the study. For standardization purposes, the block procedure will be performed by an experienced anesthesiologist who has performed at least 20 successful and uncomplicated procedures before.
Interventions
Sponsors
Samsun University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Masking description
The anesthetist who will perform the blocks will not participate in the pain follow-up of the patients. Postoperative pain assessment and data collection will be performed by another anesthetist blinded to the study.
Intervention model description
two interventional group
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* BMI \< 35 kg/m² Patients with ASA scores I, II, III
Exclusion criteria
* Patients who do not want to be included in the study Psychiatric and neurological disease with blurred consciousness Patients with ASA \> 3 BMI \> 35 kg/m² Abnormality in coagulation parameters History of allergy to local anesthetic drugs Infection at the injection site Patients whose surgical procedure time exceeds 150 minutes
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Morphine consumption in the first 24 hours postoperatively | up to 24 hours | Morfin consumption in the first 24 hours after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain density | up to 24 hours. | NRS scores (Numeric rating scale; 0: no pain, 10: severe pain) in the first 24 hours after surgery |
| Quality of recovery | 24 hours after surgery | QR15 scores |
| Nausea and vomiting | up to 24 hours | Nausea and vomiting scores in the first 24 hours (verbal rating scale; 0= none, 1= nausea, 2= gagging, 3= vomiting) |
| shoulder pain | up to 24 hours | postoperative shoulder pain;shoulder pain will be evaluated as present/absent |
Countries
Turkey (Türkiye)
Contacts
Primary Contactgamze ertaş, specialist
Backup Contacthamiyet şenol çakmak, specialist
Outcome results
None listed