Postoperative Pain, Thoracic Surgery
Conditions
Keywords
Video-Assisted Thoracic Surgery, VATS, Serratus Posterior Superior Intercostal Plane Block, Rhomboid Intercostal and Subserratus Block, Diaphragmatic Excursion, Peak Expiratory Flow
Brief summary
This prospective randomized controlled study aims to compare the effects of Serratus Posterior Superior Intercostal Plane (SPSIP) block and Rhomboid Intercostal and Subserratus (RISS) block on postoperative pain, respiratory function, and recovery quality in patients undergoing volume-preserving video-assisted thoracoscopic surgery (VATS). Eighty-four patients will be randomized in a 1:1 ratio to receive either SPSIP block or RISS block. The primary outcome is the incidence of somatic pain at the chest drain insertion site at postoperative 2 hours. Secondary outcomes include pain scores, opioid consumption, quality of recovery, diaphragmatic function, pulmonary function, rescue analgesic requirements, postoperative nausea and vomiting, and block-related complications.
Detailed description
Video-assisted thoracoscopic surgery (VATS) is associated with significant postoperative pain that may impair respiratory function and delay recovery. Regional anesthesia techniques are increasingly used to improve analgesia while minimizing opioid-related adverse effects. The Serratus Posterior Superior Intercostal Plane (SPSIP) block and the Rhomboid Intercostal and Subserratus (RISS) block are novel ultrasound-guided fascial plane blocks that provide thoracic analgesia through different mechanisms. However, comparative clinical evidence regarding their efficacy in VATS patients remains limited. This prospective, randomized, controlled study will enroll 84 adult patients scheduled for volume-preserving VATS. Participants will be randomly assigned to receive either SPSIP block or RISS block in a 1:1 ratio (42 patients per group). The primary endpoint is the incidence of somatic pain at the chest drain insertion site at postoperative 2 hours. Secondary endpoints include postoperative pain scores at rest and during movement, total intravenous morphine consumption during the first 24 postoperative hours, Quality of Recovery-15 (QoR-15) score at postoperative 24 hours, diaphragmatic excursion measured by ultrasonography, peak expiratory flow measurements, rescue analgesic requirements, time to first rescue analgesia, incidence of postoperative nausea and vomiting, and block-related complications. The study has been approved by the Bursa Sehir Hospital Clinical Research Ethics Committee and will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice principles.
Interventions
PROCEDURESerratus posterior superior intercostal plane block
Ultrasound-guided Serratus Posterior Superior Intercostal Plane (SPSIP) block performed before induction of general anesthesia using local anesthetic for postoperative analgesia in patients undergoing video-assisted thoracic surgery.
Ultrasound-guided Rhomboid Intercostal and Subserratus (RISS) block performed before induction of general anesthesia using local anesthetic for postoperative analgesia in patients undergoing video-assisted thoracic surgery.
Sponsors
Ferit Yetik
Bursa Sehir Hastanesi
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
Participants, outcome assessors, and investigators responsible for postoperative data collection and analysis will remain blinded to group allocation throughout the study period. Block procedures will be performed by an anesthesiologist not involved in postoperative assessments.
Intervention model description
Prospective, randomized, double-blind, parallel-group clinical trial comparing Serratus Posterior Superior Intercostal Plane (SPSIP) block and Rhomboid Intercostal and Subserratus (RISS) block for postoperative analgesia after video-assisted thoracic surgery (VATS). Eighty-four participants will be randomized in a 1:1 ratio to receive SPSIP block or RISS block.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Patients scheduled for elective biportal video-assisted thoracoscopic surgery (VATS) with lung parenchyma-preserving thoracic procedures under general anesthesia * American Society of Anesthesiologists (ASA) physical status I-III * Age between 18 and 75 years * Provision of written informed consent
Exclusion criteria
* Use of anticoagulant or antiplatelet therapy * Bleeding diathesis * Known allergy to local anesthetics * Infection at the planned block site * Severe chronic pulmonary disease or advanced respiratory failure (e.g., severe COPD or restrictive lung disease) * Cognitive impairment preventing reliable NRS assessment * Pregnancy or lactation * Chronic opioid use (regular use for ≥3 months) * Severe hepatic or renal failure * Refusal to participate * Technical failure or unsuccessful regional block * Conversion to open thoracotomy during surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Somatic Pain at Chest Tube Insertion Site | Postoperative 2 hours | Incidence of somatic pain localized at the chest tube insertion site, defined as sharp localized pain aggravated by coughing or deep inspiration, recorded as present or absent. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Scores at Rest | Postoperative 2, 6, 12, and 24 hours | Static postoperative pain scores assessed using the Numeric Rating Scale (NRS) at rest. |
| Postoperative Pain Scores During Movement | Postoperative 2, 6, 12, and 24 hours | Dynamic postoperative pain scores assessed using the Numeric Rating Scale (NRS) during movement. |
| Total Intravenous Morphine Consumption | Postoperative 24 hours | Total intravenous morphine consumption during the first 24 hours after surgery. |
| Interval Intravenous Morphine Consumption | Postoperative 0-8, 8-16, and 16-24 hours | Intravenous morphine consumption recorded separately for postoperative 0-8, 8-16, and 16-24 hour intervals. |
| Right Hemidiaphragm Excursion | Preoperative and postoperative 6 hours | Right hemidiaphragm excursion measured by ultrasonography to evaluate diaphragmatic function. |
| Peak Expiratory Flow | Preoperative and postoperative 6 hours | Peak expiratory flow measured using a peak flowmeter to evaluate respiratory performance. |
| Quality of Recovery-15 Score | Postoperative 24 hours | Postoperative recovery quality assessed using the Quality of Recovery-15 (QoR-15) questionnaire. |
Countries
Turkey (Türkiye)
Contacts
CONTACTYusuf Alan
Outcome results
None listed