Ultrasound-Guided Erector Spinae Plane Block Versus Thoracoscopically-Guided Intercostal Nerve Block in Video-Assisted Thoracoscopic Surgery

NCT07535697 | Recruiting

• 1 other identifier: 2025-4161-evBO
• Study Type: interventional
• Target: 72
• Locations: 1 country
• Sites: 1

Brief Summary

Effective postoperative pain management is essential after thoracic surgery. Insufficient pain control may impair breathing and coughing, increasing the risk of pulmonary complications such as collapsed lungs (atelectasis) or pneumonia. Although minimally invasive lung surgery (video-assisted thoracoscopic surgery, VATS) is less painful than open surgery, people can still have significant pain after the operation. The goal of this randomized comparative study is to compare two commonly used regional anesthesia techniques for pain control after VATS in adults. Researchers will compare an ultrasound-guided erector spinae plane block (ESPB), performed by anesthesiologists, to a thoracoscopically-guided intercostal nerve block (ICNB), performed by surgeons. Participants will:

• Undergo elective VATS lung resection surgery
• Receive either ESPB or ICNB, according to random assignment
• Have the received amount of analgesics recorded during the first 24 hours
• Have their pain levels assessed at predefined time points after surgery The main questions this study aims to answer are:
• Does ESPB result in similar analgesic consumption in the first 24 hours after surgery?
• Does ESPB provide similar postoperative pain relief compared to ICNB?
• Is the time needed to perform ESPB similar to ICNB?

Conditions

Regional Anesthesia; Video-assisted Thoracoscopic Surgery (VATS); Erector Spinae Plane Block; Intercostal Nerve Block

Keywords

Regional Anesthesia; Video-assisted Thoracoscopic Surgery (VATS); Erector Spinae Plane Block; ESPB; Intercostal Nerve Block; ICNB

Outcome Measures

Primary Outcomes (1)

• Assessment of the postoperative analgesic consumption within the first 24 hours after surgery

  Postoperative analgesic consumption is recorded during the first 24 hours after surgery. Both total opioid consumption and use of non-opioid analgesics (e.g., metamizole, paracetamol) are documented.

  First 24 hours after surgery

Secondary Outcomes (2)

• Assessment of the postoperative pain perception using the Numeric Rating Scale (NRS) pain scale

  First 24 hours after surgery

• Duration of the chest wall block

  Perioperatively

Other Outcomes (2)

• Incidence of postoperative nausea and vomiting (PONV)

  First 24 hours after surgery

• Incidence of complications

  First 24 hours after surgery

Study Arms (2)

Anesthesiological, Ultrasound-Guided "Erector Spine Plane Block" (ESPB)

ACTIVE COMPARATOR

Procedure: Anesthesiological, Ultrasound-Guided "Erector Spine Plane Block" (ESPB)

Surgical, Thoracoscopically-Guided "Intercostal Nerve Block" (ICNB)

ACTIVE COMPARATOR

Procedure: Surgical, Thoracoscopically-Guided "Intercostal Nerve Block" (ICNB)

Interventions

Anesthesiological, Ultrasound-Guided "Erector Spine Plane Block" (ESPB) PROCEDURE

The ultrasound-guided Erector Spinae Plane Block (ESPB) is performed by experienced anesthesiologists prior to induction of general anesthesia and before the start of surgery. Standard sterile precautions are applied. The fifth and sixth thoracic vertebrae are identified using anatomical landmarks and, if needed, ultrasound guidance. An ultrasound probe is positioned in a paramedian sagittal orientation approximately 2 cm lateral to the spinous process to visualize relevant anatomical structures. An in-plane needle technique is used, advancing the needle in a cranial-to-caudal direction under continuous ultrasound visualization. The needle tip is positioned in the subfascial plane beneath the erector spinae muscle at the level of the transverse process. Correct positioning is confirmed using hydrodissection. The local anesthetic is administered incrementally under continuous ultrasound guidance with repeated negative aspiration. A total of 25 mL of ropivacaine 0.375% is injected.

Anesthesiological, Ultrasound-Guided "Erector Spine Plane Block" (ESPB)

Surgical, Thoracoscopically-Guided "Intercostal Nerve Block" (ICNB) PROCEDURE

The thoracoscopically-guided Intercostal Nerve Block (ICNB) is performed by the surgeon intraoperatively immediately after insertion of the thoracoscope and before the start of surgery. Standard sterile precautions are applied. The block is performed percutaneously under continuous thoracoscopic visualization. The needle is advanced to the intercostal space, targeting the neurovascular bundle in the costal groove. Injections are performed at the level of the trocar insertion and in the two intercostal spaces cranial and caudal to it. The spread of the local anesthetic is visualized thoracoscopically to ensure correct placement and to avoid pleural perforation. A volume of 5 mL is administered per level, resulting in a total of 25 mL of ropivacaine 0.375%.

Surgical, Thoracoscopically-Guided "Intercostal Nerve Block" (ICNB)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Provision of written informed consent
• Adults (≥ 18 years of age)
• Elective video-assisted thoracoscopic surgery (VATS) for pulmonary resection (e.g., lobectomy, segmentectomy, wedge resection)

You may not qualify if:

• Lack of informed consent
• Language barrier
• Pregnancy or breastfeeding
• Known allergy to local anesthetics used in the study
• Infection at the injection site(s)
• History of complex chest wall surgery
• Revision surgery with a prior operation within the last 6 months
• Intraoperative conversion to open thoracotomy
• Chronic pain syndrome
• Fibromyalgia
• Chronic opioid use
• Chronic alcohol abuse
• Chronic substance abuse (e.g., THC, amphetamines, cocaine)
• History of psychiatric disorders (e.g., depression, schizophrenia)
• Impaired consciousness, cognition, or ability to communicate

Sponsors & Collaborators

• Sana Klinikum Offenbach: lead

Study Sites (1)

Sana Klinikum Offenbach

Offenbach, Hesse, 63069, Germany

RECRUITING

MeSH Terms

Interventions

Surgical Procedures, Operative

Study Officials

• Haitham Mutlak, Prof. Dr.

  Department of Anesthesiology, Intensive Care Medicine and Pain Therapy at Sana Klinikum Offenbach

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Prof. Dr. H. Mutlak

CONTACT

0049-69-8405-3802; haitham.mutlak@sana.de

E. Park, MD

CONTACT

eunji.park@sana.de

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Head of Department of Anesthesiology

Study Record Dates

• First Submitted: April 10, 2026
• First Posted: April 17, 2026
• Study Start: May 4, 2026
• Primary Completion (Estimated): April 30, 2027
• Study Completion (Estimated): May 3, 2027
• Last Updated: May 1, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

DE (1)