Postoperative Opioid Consumption of Serratus Posterior Superior Intercostal Plane Block Versus Thoracic Paravertebral Block

NCT07613697 | Active Not Recruiting

• 1 other identifier: ZU-IRB # 2312
• Study Type: interventional
• Target: 48
• Locations: 1 country
• Sites: 1

Brief Summary

Previous studies found that paravertebral and thoracic epidural continuous infusions of opioid-free local anaesthetic were found to be comparable, but paravertebral analgesia (PVA) was associated with less respiratory complications and hypotension. The newly emerging Serratus posterior superior intercostal plane block (SPSIPB) provided excellent analgesia in most studies that have focused on video-assissted thoracoscopic surgery (VATS) and breast surgery. The aim of this clinical trial is to achieve better high quality pain control with less opioid consumption either by Serratus Posterior Superior Intercostal Plane Block (SPSIPB) or Thoracic Paravertebral Block after Open thoracotomy. This study will assess and compare the analgesic efficacy of both blocks to reduce opioid consumption, the efficacy of both blocks on postoperative respiratory functions after open thoracotomy. The main question it aims to answer is: Is there a difference between Serratus Posterior Superior Intercostal Plane Block (SPSIPB) and Thoracic Paravertebral block following open thoracotomy as regard postoperative opioid consumption, postoperative pain score, and postoperative respiratory functions? All patients will take a single dose of local anesthesia either through serratus posterior superior intercostal plane block (SPSIPB) or thoracic paravertebral block and the end of open thoracotomy then total opiod consumption willbe recorded after 24 hours postoperatively.

Conditions

Opioid Consumption, Postoperative

Keywords

Open Thoracotomy; Serratus Posterior Superior Intercostal Plane Block; Thoracic Paravertebral Block

Outcome Measures

Primary Outcomes (1)

• Total opioid consumption

  Total first 24 hours opioid consumption

  up to 24 hours postoperative

Secondary Outcomes (5)

• Time of the block performance

  perioperative

• 1st time for rescue analgesia

  perioperative

• Postoperative pain score

  2 hours, 4 hours, 6 hours, 12 hours, 18 hours, 24 hours postoperative

• Forced expiratory volume in 1 second (FEV1)

  baseline, 2 hours, 4 hours, 6 hours, 12, hours, 18 hours, 24 hours postoperative

• Patient satisfaction

  24 hours postoperative

Study Arms (2)

Group S (Serratus Posterior Superior Intercostal Plane Block group)

ACTIVE COMPARATOR

patients will receive ultrasound-guided serratus posterior superior intercostal plane block

Procedure: Serratus Posterior Superior Intercostal Plane Block (single injection)

Group P (Paravertebral Block group)

ACTIVE COMPARATOR

patients will receive ultrasound guided thoracic paravertebral nerve block

Procedure: Thoracic Paravertebral block (single injection)

Interventions

Serratus Posterior Superior Intercostal Plane Block (single injection) PROCEDURE

As described by Tulger et al., the block will be performed by a high-frequency (7-12 MHz) linear ultrasound probe. After slight scapular lateral displacement, the probe will be placed transversely at the level of the scapular spine. The upper border of the scapula, trapezius muscle, serratus posterior superior muscle (SPSM), and 2nd and 3rd ribs will be visualized. Using in-plane technique, the 80 mm block needle will be introduced from the level of the 3rd rib in the caudocranial direction through the medial scapular border passes through the skin and subcutaneous tissue to target the 3rd rib. After negative aspiration, the needle tip will be placed between the 3rd rib and the SPSM, hydro-dissection using 1-2 ml saline to ensure the correct needle placement then 30 ml of 0.25% bupivacaine will be injected between the SPSM and the 3rd rib.

Group S (Serratus Posterior Superior Intercostal Plane Block group)

Thoracic Paravertebral block (single injection) PROCEDURE

A high-frequency (7-12 MHz) linear ultrasound probe will be placed 2-3cm lateral to the upper edge of the spinous process of the 5th thoracic vertebrae body which identified by counting down from the seventh cervical vertebrae. After visualizing the transverse process, the underlying muscles, the paravertebral space, the internal intercostal membrane, and the pleura, 80 mm block needle will be inroduced by the in-plane technique till the paravertebral space over the superior border of the transverse process. After identification of the paravertebral space using a loss of resistance technique, 30 ml of 0.25% bupivacaine will be injected.

Group P (Paravertebral Block group)

Eligibility Criteria

• Age: 21 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• BMI (25-35kg/m²).
• Physical status: ASA I-II - III.
• Patients undergoing posterolateral thoracotomy for lung resection.

You may not qualify if:

• Emergency surgeries.
• Uncooperative patient.
• History of allergy to study drugs.
• Patients with coagulation disorders, advanced hepatic, renal, cardiovascular, respiratory disease and neuropsychiatric disorders (e.g. Alzheimer, Dementia, Delirium, mental retardation and cognitive dysfunction).
• Infection at the site of block .

Sponsors & Collaborators

• Zagazig University: lead

Study Sites (1)

Zagazig university hospitals

Zagazig, Sharqia Province, Egypt

Location

MeSH Terms

Interventions

Injections

Intervention Hierarchy (Ancestors)

Drug Administration Routes; Drug Therapy; Therapeutics

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 22, 2026
• First Posted: May 29, 2026
• Study Start: May 15, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 15, 2026
• Last Updated: May 29, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

EG (1)