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Video-assisted thoracic surgery (VATS) is widely performed for the management of various thoracic pathologies and is generally associated with reduced surgical trauma compared with open thoracotomy. Nevertheless, patients may still experience considerable postoperative pain, which can adversely affect respiratory function, mobilization, and recovery. Various regional analgesic techniques have been incorporated into multimodal pain management strategies for VATS, including thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), intercostal nerve block, serratus anterior plane block (SAPB), rhomboid intercostal block (RIB), and serratus posterior superior intercostal plane block (SPSIPB). Among these approaches, ultrasound-guided TPVB has traditionally been regarded as a reference regional analgesic technique. More recently, interfascial plane blocks have gained increasing attention because of their technical simplicity and favorable safety profile. RIB and SPSIPB are two novel interfascial plane blocks that may provide effective postoperative analgesia following thoracic surgery. The present study aims to compare the analgesic efficacy of RIB and SPSIPB in patients undergoing VATS and to evaluate their impact on postoperative pain outcomes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Rhomboid Intercostal Block | Active Comparator | For patients scheduled to receive a Rhomboid Intercostal Block (RIB), after sonographic identification of the relevant anatomical structures, the block needle is advanced using an in-plane ultrasound-guided technique beneath the rhomboid muscle until contact with the rib is achieved. Following hydrodissection with 2 mL of normal saline to confirm correct needle placement, 30 mL of 0.25% bupivacaine is injected into the interfascial plane. |
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| Serratus Posterior Superior Intercostal Plane Block | Active Comparator | For patients scheduled to receive a Serratus Posterior Superior Intercostal Plane Block (SPSIPB), after sonographic identification of the relevant anatomical structures, the block needle is advanced using an in-plane ultrasound-guided technique beneath the serratus posterior superior muscle until contact with the rib is achieved. Following hydrodissection with 2 mL of normal saline to confirm correct needle placement, 30 mL of 0.25% bupivacaine is injected into the interfascial plane. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Rhomboid Intercostal Block | Drug | Rhomboid intercostal block will be applied to the patients under real-time ultrasound guidance. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Surgical Pain Scores | Surgical pain will be assessed at rest and while coughing using the visual analog scale on a scale from 0mm (no pain) to 100mm (worst pain). Pain assessment will be done at 1st, 6th, 12th, and 24th hours after surgery. | 24 hours after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Shoulder Pain Scores | Shoulder pain will be assessed at rest and while coughing using the visual analog scale on a scale from 0mm (no pain) to 100mm (worst pain). Pain assessment will be done at 1st, 6th, 12th, and 24th hours after surgery. | 24 hours after surgery |
| Intraoperative remifentanil consumption |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Emine Nilgün Zengin, Associate Professor | Contact | 00905063370548 | nilbavullu@gmail.com | |
| Hülya Yiğit, Associate Professor | Contact | 00905054853939 | yigitozay@hotmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ankara City Hospital | Recruiting | Çankaya | Ankara | 06290 | Turkey (Türkiye) |
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| Serratus Posterior Superior Intercostal Plane Block | Drug | Serratus posterior superior intercostal plane block will be applied to the patients under real-time ultrasound guidance. |
|
The amount of remifentanil that patients need to maintain anesthesia during the intraoperative period will be recorded. |
| During the intraoperative period |
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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