Analgesic Efficiency of SIPSPB vs ICNB in VATS Surgery

Kocaeli City Hospital

Status: Enrolling

Conditions: Post-operative Pain Management; Serratus Posterior Superior Intercostal Plane Block; Intercostal Nerve Block; VATS

Study type: Observational

Funder types: Other

Identifiers

NCT07577908

250125

Details and patient eligibility

About

This study aims to evaluate the effectiveness of Serratus Posterior Superior Intercostal Plane (SPSIP) block compared to Intercostal Nerve (ICN) block in terms of postoperative pain control, reduction of opioid analgesic consumption, minimization of postoperative respiratory complications, and increase patient satisfaction (using a 5-point Likert scale) in patients undergoing video-assisted thoracoscopic surgery (VATS).

Full description

In this prospective observational study, patients included in the study will receive Serratus Posterior Superior Intercostal Plane (SPSIP) block and Intercostal Nerve (ICN) block for postoperative analgesia at the end of surgery. The SPSIP block will be performed by the anesthesiologist under ultrasound guidance immediately after skin closure and before extubation, while the ICN block will be performed by the surgeon under direct vision immediately before skin closure.

At the end of surgery, patients will receive 1000 mg paracetamol and 50 mg dexketoprofen during skin closure. Upon arrival at the recovery room, each patient will be connected to a patient-controlled analgesia (PCA) pump containing tramadol. At postoperative reassessment, patients with a Numerical Pain Rating Scale (NPRS) score greater than 4 despite PCA use will receive a rescue analgesic dose of 50 mg dexketoprofen.

Postoperative pain intensity will be assessed using the NPRS (Numerical Pain Rating Scale) at 1, 4, 6, 12, 18, and 24 hours postoperatively, both at rest and during coughing. Total opioid consumption, rescue analgesic use, and postoperative complications will be recorded.

Patients will be informed about their level of surgical satisfaction 24 hours after surgery, and this information will be recorded.

Enrollment: 80 estimated patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Aged 18-80 years,
• American Society of Anesthesiologists (ASA) physical status I-III
• Patients who have provided informed consent to participate in the study

Exclusion criteria

• Patients who refuse to participate in the study by not signing the informed consent
• Patients classified as ASA > 3, according to the system established by the American Society of Anesthesiologists
• Patients unable to understand the use of the NPR Scale or the PCA device that will be used for postoperative analgesia
• Coagulation disorders or anticoagulant therapy contraindicating regional anesthesia
• Patients with allergies to analgesic and/or anesthetic drugs
• Infection at the block injection site
• Patients whose surgical procedure is intraoperatively converted to an open pulmonary resection

Trial design

80 participants in 2 patient groups

Group SPSIP Block

Description:

In patients meeting the inclusion criteria for the study, an ultrasound-guided interfacial plane block is applied between the posterior superior serratus muscle and the underlying ribs in patients undergoing SPSIP block after VATS.

Group ICN Block

Description:

Patients meeting the inclusion criteria for the study who will undergo intercostal nerve block after VATS will have a total of 10 ml of 0.5% bupivacaine applied to two segments (upper and lower segments of the incision line) under direct vision by the surgeon while the patient is in the lateral decubitus position at the end of the operation and immediately before skin closure.