The purpose of this study is to find out which pain relief method works better for people having video-assisted thoracoscopic surgery. We will compare two techniques: thoracic paravertebral block (TPVB), a numbing injection near the spine, and intrathecal morphine (ITM), a small dose of morphine injected into the spinal fluid. We want to see if ITM works as well as TPVB in reducing the need for pain medicine during the first 24 hours after surgery. People in the study will get either TPVB or ITM before going to sleep for surgery, use a patient-controlled pain pump after surgery, and have their pain scores, medicine use, recovery, and possible side effects checked for up to 30 days after surgery.

This study will compare two different pain control techniques for people having video-assisted thoracoscopic surgery (VATS), a minimally invasive chest operation. The first technique, called thoracic paravertebral block (TPVB), involves injecting numbing medicine near the spine to block pain from the surgical area. The second technique, intrathecal morphine (ITM), involves giving a small dose of morphine into the spinal fluid to provide pain relief after surgery.

The main goal is to find out if ITM works as well as TPVB in reducing the need for additional pain medicine during the first 24 hours after surgery. This is a randomized controlled trial, meaning participants will be randomly assigned to one of the two groups. Everyone will receive general anesthesia for their surgery and will use a patient-controlled analgesia pump afterwards, along with regular pain medicines such as paracetamol and tenoxicam.

Pain scores, the amount of pain medicine used, and recovery quality will be measured at regular times in the first 24 hours after surgery. We will also monitor side effects such as nausea, vomiting, itching, or breathing problems. All patients will be followed for 30 days after surgery to check for any complications.

Inclusion Criteria

1. Age between 18 and 75 years
2. American Society of Anesthesiologists (ASA) physical status I-III
3. Scheduled for elective video-assisted thoracoscopic surgery (VATS) for wedge resection, segmentectomy, or lobectomy
4. Ability to understand the study protocol and provide written informed consent

Exclusion Criteria

1. Refusal to participate
2. Pregnancy
3. Morbid obesity (body mass index > 30)
4. Known allergy to opioids, local anesthetics, or NSAIDs
5. History of neuropsychiatric disorder, cognitive impairment, or inability to communicate with investigators
6. History of substance abuse
7. Current anticoagulant use or known bleeding disorder
8. Presence of systemic infection
9. Significant cardiovascular, hepatic, renal, or endocrine disease
10. History of chronic pain syndromes or chronic pain treatment
11. Emergency surgery or previous ipsilateral VATS or thoracotomy
12. Preoperative chronic opioid therapy within 3 months (≥15 mg/day for ≥30 days)
13. Severe intraoperative or postoperative bleeding, hemodynamic instability
14. Requirement for prolonged postoperative ventilation (> 18 hours)

De-identified individual participant data (including baseline characteristics, intraoperative and postoperative outcome measures, and adverse events) will be shared with researchers upon reasonable request for academic purposes. Data will be available beginning 6 months after publication of the primary results and for up to 5 years. Access will be granted following approval of a written proposal and data use agreement.