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This study aims to evaluate the efficacy of ultrasound-guided Serratus Posterior Superior (SPS) block compared to surgeon-administered intercostal blockade in preventing chronic pain at 3, 6, and 12 months following Video-Assisted Thoracoscopic Surgery (VATS).
Although VATS is a minimally invasive technique, chronic post-thoracotomy pain (CPTP) remains a significant complication due to intercostal nerve injury. This study investigates whether the preemptive analgesic effect of the SPS block, performed under ultrasound guidance before surgery, reduces the incidence and severity of chronic pain more effectively than standard surgical intercostal blocks. Secondary objectives include assessing acute pain scores (VAS/NRS) within the first 24 hours, total opioid consumption, and duration of hospital stay.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| SPS Block Group | Experimental | SPS Block will be performed at the end of the surgery |
|
| Surgical Intercostal Blockade Group | Active Comparator | Surgical Intercostal Blockade will be performed at the end of the surgery by the surgeon |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| SPS block | Drug | 30 mL of 0.25% Bupivacaine will be injected into the plane between the Serratus Posterior Superior muscle and the intercostal muscles at the scapular level. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Incidence and severity of Chronic Post-Thoracotomy Pain (CPTP) | The primary aim is to compare incidence and severity of Chronic Post-Thoracotomy Pain with McGill Pain Questionnaire (MPQ). | Incidence and severity of Chronic Post-Thoracotomy Pain (CPTP) at 3, 6, and 12 months post-surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| Opioid consumption (Fentanyl PCA) | The primary aim is to compare postoperative opioid consumption from the PCA device. | Changes from baseline opioid consumption at postoperative 1, 2, 4, 8, 16 and 24 hours. |
| Pain scores (Numerical rating scale-NRS) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Bahadir Ciftci, Assoc Prof, MD | Contact | +905343736865 | bciftci@medipol.edu.tr | |
| Ayse Cicek | Contact |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Istanbul Medipol University Hospital | Recruiting | Istanbul | Bagcilar | 34070 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38240640 | Background | Ciftci B, Alver S, Ahiskalioglu A, Bilal B, Tulgar S. Serratus posterior superior intercostal plane block: novel thoracic paraspinal block for thoracoscopic and shoulder surgery. Minerva Anestesiol. 2024 Apr;90(4):345-347. doi: 10.23736/S0375-9393.23.17827-8. Epub 2024 Jan 19. No abstract available. | |
| 40473018 | Background |
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We will not plan to share IPD
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| ID | Term |
|---|---|
| D009437 | Neuralgia |
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
| D009422 | Nervous System Diseases |
| D010146 | Pain |
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There are two models for this study. The first group is the SPS block. The second one is the Surgical Intercostal Blockade group.
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The patients will be blind to the study groups.
| Surgical Intercostal Blockade. | Drug | At the end of the operation, the surgeon will perform an injection of a total of 30 mL of 0.25% Bupivacaine into three intercostal nerves above and below the incision site under direct thoracoscopic visualization. |
|
The secondary aim is to compare NRS at the postoperative 24 h. Postoperative pain assessment will be performed using the NRS (0 = no pain, 10 = the most severe pain felt). The NRS scores will be recorded
| Changes from baseline pain scores at postoperative 1, 2, 4, 8, 16 and 24 hours |
| Need for rescue analgesia (meperidine) | The secondary aim is to compare rescue analgesia used in the postoperative 24 h. | Postoperative 24 hours period |
| Adverse events | The secondary aim is to compare the adverse events (nausea, vomiting, itching) related to opioid use | Postoperative 24 hours period |
| Incidence and severity of Chronic Post-Thoracotomy Pain (CPTP) | The secondary aim is to compare ncidence and severity of Chronic Post-Thoracotomy Pain with Neuropathic pain characteristics using LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) and McGill Pain Questionnaire (MPQ). | Incidence and severity of Chronic Post-Thoracotomy Pain (CPTP) at 3, 6, and 12 months post-surgery. |
| Dogan G, Kucuk O, Kayir S, Dal GC, Ciftci B, Zengin M, Alagoz A. Serratus posterior superior intercostal plane block versus thoracic paravertebral block for pain management after video-assisted thoracoscopic surgery: a randomized prospective study. Braz J Anesthesiol. 2025 Sep-Oct;75(5):844647. doi: 10.1016/j.bjane.2025.844647. Epub 2025 Jun 3. |
| 41591369 | Background | Cevikkalp E, Ulusoy E, Karakaya M, Ekinci M, Dikici M. Serratus posterior superior intercostal block as a component of multimodal analgesia in thoracotomy. Minerva Anestesiol. 2026 Mar;92(3):239-241. doi: 10.23736/S0375-9393.25.19490-X. Epub 2026 Jan 27. No abstract available. |
| 41533022 | Background | Ozen V, Turan EI, Alver S, Sahin AS, Ciftci B. Combination of Fascial Plane Blocks Including Serratus Posterior Superior Intercostal Plane Block for Pediatric Thoracic Analgesia: Two Case Reports. A A Pract. 2026 Jan 14;20(1):e02144. doi: 10.1213/XAA.0000000000002144. eCollection 2026 Jan 1. |
| D009461 |
| Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |