SPSIP Block vs SAP Block for Post-VATS Pain

NCT07467291 | Completed

• 1 other identifier: 43757
• Study Type: observational
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

Comparison of Superior Serratus Posterior Intercostal Plane Block and Serratus Anterior Plane Block for Pain Management Following Video-Assisted Thoracoscopic Surgery: A Prospective Observational Cohort 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, direct comparisons with SPSIPB are limited. Therefore, this prospective observational cohort study aimed to compare postoperative analgesic outcomes in patients undergoing uniportal VATS who received either ultrasound-guided SPSIPB or SAPB, with the block type selected by the attending anesthesiologist as part of routine clinical care.

Conditions

Postoperative Pain; Video-Assisted Thoracoscopic Surgery

Keywords

VATS; Serrratus Posterior Superior İnterfascial Plane Block; Serratus Anterior Plane Block; Postoperative Analgesia; Numeric Rating Scale

Outcome Measures

Primary Outcomes (1)

• To determine the effectiveness of ultrasound-guided SPSIP block versus SAP block after VATS using postoperative NRS pain scores.

  The NRS score is based on the patient rating their pain on a scale from 0 to 10. Zero indicates no pain, while 10 indicates the most severe pain possible.

  NRS scores will be assessed upon admission to the post-anesthesia care unit (0 min), at 30 minutes, and at 1, 6, 12, 18, and 24 hours postoperatively.

Secondary Outcomes (4)

• QoR-15 recovery score

  up to 48 hours

• Time to first rescue analgesia

  up to 24 hours

• The total amount of rescue analgesic consumption

  up to 24 hours

• The incidence of block-related complications.

  up to 48 hours

Study Arms (2)

Serratus posterior superior intercostal plane block Group

Patients who received an ultrasound-guided serratus posterior superior intercostal plane block (30 mL of 0.25% bupivacaine) at the end of uniportal VATS for postoperative analgesia. The block type was selected by the attending anesthesiologist as part of routine clinical care; patients were not randomized.

Procedure: Serratus posterior superior intercostal plane block

Serratus Anterior Plane Block (SAPB) group

Patients who received an ultrasound-guided serratus anterior plane block (30 mL of 0.25% bupivacaine) at the end of uniportal VATS for postoperative analgesia. The block type was selected by the attending anesthesiologist as part of routine clinical care; patients were not randomized.

Procedure: Serratus Anterior Plane Block (SAPB) group

Interventions

Serratus Anterior Plane Block (SAPB) group PROCEDURE

The block was performed with the patient in the lateral decubitus position. Ultrasound-guided SAPB was performed by the same anesthesiologist with over three years of experience in ultrasound-guided regional anesthesia, using a high-frequency linear probe (LOGIQ e Ultrasound, GE HealthCare, United States). The probe was positioned parallel to the mid-axillary line, and the ribs were readily identified as hyperechogenic lines. The fifth rib was identified in the mid-axillary line. Using an in-plane technique, the needle was placed in the myofascial plane between the serratus anterior muscle and the fifth rib, and 30 mL of 0.25% bupivacaine was injected.

Serratus Anterior Plane Block (SAPB) group

Serratus posterior superior intercostal plane block PROCEDURE

The procedure was performed with the patient in the lateral decubitus position. After a slight lateral displacement of the scapula, the scapular spine was visualized with ultrasound, and the probe was moved medially. After locating the tip of the scapular spine, the probe was placed sagittally at the superior angle of the scapula, and the third rib was visualized. The block needle was advanced craniocaudally and placed between the posterior superior serratus muscle and the third rib. Hydrodissection was performed with an injection of 2 mL of saline to confirm block needle placement. After confirming the block site, 30 mL of 0.25% bupivacaine was injected.

Serratus posterior superior intercostal plane block Group

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adult patients undergoing elective uniportal video-assisted thoracoscopic surgery at Firat University Hospital who received either a serratus anterior plane block or a serratus posterior superior intercostal plane block for postoperative analgesia as part of routine care.

You may qualify if:

• 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.

You may not qualify if:

• 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;

Sponsors & Collaborators

• Firat University: lead

Study Sites (1)

Fırat University Faculty of Medicine Hospital

Elâzığ, 23100, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Pain, Postoperative

Interventions

Saposins; Population Groups

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Intervention Hierarchy (Ancestors)

Sphingolipid Activator Proteins; Coenzymes; Enzymes and Coenzymes; Demography; Population Characteristics

Study Officials

• Ahmet Aksu, MD

  Firat University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: February 6, 2026
• First Posted: March 12, 2026
• Study Start: March 13, 2026
• Primary Completion: August 1, 2026
• Study Completion: August 1, 2026
• Last Updated: October 2, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)