Comparison of Superior Serratus Posterior Intercostal Plane Block and Serratus Anterior Plane Block for Pain Management Following Video-Assisted Thoracoscopic Surgery: A Randomized Prospective Study

Introduction Video-assisted thoracoscopic surgery (VATS) is associated with lower postoperative pain, shorter hospital stays, and better preservation of pulmonary function compared with conventional thoracotomy, owing to its minimally invasive nature. Although VATS was initially performed using a multi-port technique, it has evolved into a single-port approach, reflecting advances in surgical techniques and equipment. In Uniportal VATS, limiting surgical trauma to a single intercostal space may reduce the risk of chronic postoperative pain by decreasing intercostal nerve damage.

Because inadequate pain control after VATS may predispose patients to developing chronic post-thoracotomy pain syndrome (PTPS), effective postoperative analgesia is critically important. Therefore, regional analgesic techniques are recommended as part of multimodal analgesia. PROSPECT guidelines do not recommend the routine use of thoracic epidural analgesia for VATS, despite its effectiveness, because of its invasiveness; instead, they emphasize peripheral blocks such as paravertebral block and erector spinae plane block.

Although not included among first-line analgesic interventions in PROSPECT guidelines, the serratus anterior plane block (SAPB) is a widely used and well-established technique in thoracic surgery. In addition, the superior serratus posterior intercostal plane block (SPSIPB) is gaining attention in VATS surgery because of its analgesic effect covering the C3-T10 dermatomes.

Although there are studies in the literature comparing SAPB with different regional techniques, there is no randomized controlled trial directly comparing it with SPSIPB. Therefore, this planned study aimed to evaluate whether SPSIPB is noninferior to SAPB for postoperative analgesia and to compare the postoperative analgesic efficacy of the two techniques performed under ultrasound guidance.

Inclusion Criteria:

• aged 18-65 years,
• with American Society of Anesthesiologists (ASA) physical status classification I-III,
• Body Mass Index (BMI) < 35 kg/m²,
• and who read and signed the informed consent form were included.

Exclusion Criteria:

• inability to communicate in Turkish, refusal to consent,
• inability to use the numerical pain rating scale (NRS),
• allergy to local anesthetics or study-specific analgesics;
• pregnancy or breastfeeding;
• uncontrolled anxiety or substance dependence;
• history of thoracic surgery,
• trauma,
• neuromuscular or peripheral nerve disorders;
• diabetes mellitus,
• hepatic or renal insufficiency,
• coagulation disorders;
• chronic opioid or steroid use;
• widespread pain;
• anticoagulant therapy;
• infection at the block application site;
• early termination of surgery;
• absence of planned postoperative extubation.