Comparison Paravertebral and Serratus Anterior Plane Block in Video-assisted Thoracoscopic Surgery.

NCT07002788 | Active Not Recruiting DMC

• 1 other identifier: KA-24035
• Study Type: interventional
• Target: 122
• Locations: 1 country
• Sites: 1

Brief Summary

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive alternative to thoracotomy that emerged in the early 1990s, aiming to reduce surgical stress and postoperative pain. While VATS generally results in less pain than thoracotomy, patients may still experience significant discomfort. Effective pain control remains crucial in VATS to minimize postoperative complications, especially pulmonary and cardiac events, which can arise from inadequate ventilation and impaired sputum clearance due to pain. Various strategies have been developed to manage postoperative pain, with multimodal approaches-combining regional or peripheral blocks with systemic analgesics such as NSAIDs and adjuvants-now considered standard. Among regional techniques, serratus anterior plane (SAP) block and thoracic paravertebral block (PVB) are commonly used. SAP block targets the thoracodorsal, long thoracic, and T2-T9 spinal nerves between the latissimus dorsi and serratus anterior muscles, providing effective anterolateral chest wall analgesia. PVB targets intercostal nerves within the paravertebral space and has shown superior pain control and improved lung function compared to systemic opioids or intrapleural local anesthetics. At our center, both SAP and PVB are routinely used for postoperative analgesia in VATS procedures for patients with lung masses. Pain levels will be assessed using the Visual Analog Scale (VAS), a reliable tool for evaluating both acute and chronic pain, unaffected by age or gender. This study aims to compare the effectiveness of SAP and PVB blocks in terms of postoperative pain, opioid requirements, and block-related complications in patients undergoing VATS under general anesthesia. The research is observational and will not alter routine clinical practices.

Conditions

Lung Cancer (NSCLC); Lung Adenocarcinoma; Video Assisted Thoracic Surgery (VATS)

Keywords

paravertebral block; serratus anterior plane block; lung cancer; video-assisted thoracoscopic surgery

Outcome Measures

Primary Outcomes (2)

• Postoperative Pain Scores (VAS)

  Pain assessment will be performed by Res. Asst. Dr. Rabia Çakmak at the 1st, 3rd, 6th, 12th, and 24th hours postoperatively. Pain scores will be evaluated at rest and during coughing using the Visual Analog Scale (VAS), where 0 = no pain and 10 = worst imaginable pain.

  Within the first 24 hours after surgery

• Total Postoperative Morphine Consumption

  Total morphine consumption in the first 24 hours after surgery will be recorded by the patient-controlled analgesia (PCA) device.

  Within the first 24 hours after surgery

Secondary Outcomes (1)

• Total Rescue Analgesic Use

  Within the first 24 hours after surgery

Study Arms (2)

Paravertebral block

ACTIVE COMPARATOR

Paravertebral block: After the patient is in the lateral decubitus position and the necessary antiseptic conditions are provided, the linear probe of the ultrasound will be placed between two transverse processes in the paramedian plane on the side to be operated on, and the transverse processes and the superior costotransverse ligament and pleura will be visualized at the level of the thoracic 6-7 vertebrae. The 22 gauge 50 mm needle will be advanced in-plane with ultrasonography until it passes the superior costotransverse ligament, and 20 ml of 0.5% bupivacaine hydrochloride will be injected while the needle tip is in the thoracic paravertebral area. The spread of the local anesthetic drug and the collapse movement of the pleura will be observed on ultrasonography.

Drug: Bupivacaine; Drug: Morphine; Drug: Paracetamol; Drug: Diklofenak Sodyum

serratus anterior plane block

ACTIVE COMPARATOR

In patients who will undergo serratus anterior plane block, after the necessary antiseptic conditions are provided in the lateral decubitus position, 30 ml of 0.25% bupivacaine hydrochloride will be injected into the anatomical neurofascial space between the serratus anterior and latissimus dorsalis muscle with a 10 cm long block needle in the mid-axillary line between the 4th and 5th ribs using the linear probe of the ultrasound.

Drug: Bupivacaine; Drug: Morphine; Drug: Paracetamol; Drug: Diklofenak Sodyum

Interventions

Bupivacaine DRUG

Used for regional anesthesia during VATS procedure (e.g., paravertebral or serratus anterior plane block)

Also known as: Bupivakain

Paravertebral block; serratus anterior plane block

Morphine DRUG

Used for postoperative pain control via PCA device.

Also known as: morfin

Paravertebral block; serratus anterior plane block

Paracetamol DRUG

Used as part of postoperative multimodal analgesia

Also known as: Acetaminophen

Paravertebral block; serratus anterior plane block

Diklofenak Sodyum DRUG

Administered for postoperative pain management

Also known as: NSAID

Paravertebral block; serratus anterior plane block

Eligibility Criteria

• Age: 18 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients between the ages of 18-64 who gave consent to participate in the study
• Patients between the ages of 65-90 who received a score of 24 or more from the mini mental test and gave consent to participate in the study
• ASA 1-3 patients

You may not qualify if:

• Those with neuropathy,
• Those with renal failure,
• Those with liver failure,
• Those with coagulopathy,
• Those with local anesthetic allergy,
• Those with infection in the area where the procedure will be performed,
• Those with congenital muscle absence in the area where the block will be performed
• Patients who did not give consent to participate in the study

Sponsors & Collaborators

• Hacettepe University: lead

Study Sites (1)

Hacettepe Üniversitesi

Ankara, Turkey (Türkiye)

Location

Related Publications (4)

• Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001 Dec;8(12):1153-7. doi: 10.1111/j.1553-2712.2001.tb01132.x.

  PMID: 11733293 BACKGROUND

• Gagliese L, Katz J. Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients. Pain. 2003 May;103(1-2):11-20. doi: 10.1016/s0304-3959(02)00327-5.

  PMID: 12749954 BACKGROUND

• Sihoe ADL. Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery. Respirology. 2020 Nov;25 Suppl 2:49-60. doi: 10.1111/resp.13920. Epub 2020 Jul 30.

  PMID: 32734596 BACKGROUND

• Feray S, Lubach J, Joshi GP, Bonnet F, Van de Velde M; PROSPECT Working Group *of the European Society of Regional Anaesthesia and Pain Therapy. PROSPECT guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2022 Mar;77(3):311-325. doi: 10.1111/anae.15609. Epub 2021 Nov 5.

  PMID: 34739134 BACKGROUND

Related Links

• Link directs to a related article on the American Academy of Pain Medicine website, providing further details regarding the study's methodology and findings.

MeSH Terms

Conditions

Lung Neoplasms; Carcinoma, Non-Small-Cell Lung; Adenocarcinoma of Lung

Interventions

Bupivacaine; Morphine; Acetaminophen; Anti-Inflammatory Agents, Non-Steroidal

Condition Hierarchy (Ancestors)

Respiratory Tract Neoplasms; Thoracic Neoplasms; Neoplasms by Site; Neoplasms; Lung Diseases; Respiratory Tract Diseases; Carcinoma, Bronchogenic; Bronchial Neoplasms; Adenocarcinoma; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type

Intervention Hierarchy (Ancestors)

Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines; Morphine Derivatives; Morphinans; Opiate Alkaloids; Alkaloids; Heterocyclic Compounds; Heterocyclic Compounds, Bridged-Ring; Heterocyclic Compounds, 4 or More Rings; Heterocyclic Compounds, Fused-Ring; Phenanthrenes; Polycyclic Aromatic Hydrocarbons; Polycyclic Compounds; Acetanilides; Analgesics, Non-Narcotic; Analgesics; Sensory System Agents; Peripheral Nervous System Agents; Physiological Effects of Drugs; Pharmacologic Actions; Chemical Actions and Uses; Anti-Inflammatory Agents; Therapeutic Uses; Antirheumatic Agents

Study Officials

• murat izgi

  Hacettepe University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: assistant professor

Study Record Dates

• First Submitted: March 16, 2025
• First Posted: June 4, 2025
• Study Start: December 1, 2024
• Primary Completion: December 1, 2025
• Study Completion: January 1, 2026
• Last Updated: June 4, 2025

Record last verified: 2025-04

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, CSR
• Time Frame: 2026-2030
• Access Criteria: Individual participant data and supporting documents will be made publicly available without restriction

Locations

TU (1)