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).

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.

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

Patients who will undergo elective VATS surgery in the thoracic surgery operating room of Kocaeli City Hospital