Comparison of the Effectiveness of Midpoint Transverse Process to Pleura (MTP) Block and Erector Spinae Plane (ESP) Block in Video-Assisted Thoracoscopic Surgery (VATS) at RS Ngoerah

NCT07868484 | Recruiting

• 2 other identifiers: 2026.02.1.07052310/UN14.2.2.VII.14/LT/2026
• Study Type: interventional
• Target: 51
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized, double-blind controlled trial compares two ultrasound-guided fascial plane blocks, the midpoint transverse process to pleura (MTP) block and the erector spinae plane (ESP) block, for postoperative analgesia in adults undergoing elective video-assisted thoracoscopic surgery (VATS) at RS Ngoerah, Denpasar, Indonesia. Both blocks are performed at the T4-T5 level after induction of general anesthesia and before skin incision, with a single injection of 20 mL ropivacaine 0.375%. Participants are randomly allocated, using block randomization and sealed opaque envelopes, to the MTP block group or the ESP block group. All participants receive the same general anesthesia, the same multimodal analgesia, and the same fentanyl patient-controlled analgesia (PCA) after surgery. The primary outcome is total fentanyl consumption via PCA in the first 24 hours after surgery. Secondary outcomes are numerical rating scale (NRS) pain scores at 0, 1, 2, 4, 6, 12 and 24 hours, time to first rescue analgesia, and Quality of Recovery-15 (QoR-15) score at 24 hours. All outcomes are assessed by the Acute Pain Service team, who are blinded to group allocation. The study tests whether the MTP block, which places local anesthetic closer to the thoracic paravertebral space, differs from the ESP block in these outcomes.

Conditions

Pain; Postoperative Pain

Keywords

Erector Spinae Plane Block; Midpoint Transverse Process to Pleura Block; MTP Block; ESP Block; Video-Assisted Thoracoscopic Surgery; VATS; Ropivacaine; Fentanyl; Patient-Controlled Analgesia; Quality of Recovery-15; Fascial Plane Block

Outcome Measures

Primary Outcomes (1)

• Total fentanyl consumption via patient-controlled analgesia (PCA) in the first 24 hours after surgery

  Cumulative fentanyl dose delivered through the PCA pump over the first 24 hours after surgery, read from the cumulative PCA pump log at 24 hours and expressed in mcg per kg body weight. PCA settings: fentanyl 10 mcg/mL, demand only, demand dose 20 mcg, lockout interval 10 minutes, maximum 200 mcg per 4 hours, no background infusion, identical in both groups.

  24 hours after surgery

Secondary Outcomes (3)

• Postoperative pain intensity (Numerical Rating Scale, 0-10)

  Self-reported pain intensity on the Numerical Rating Scale (0 = no pain, 10 = worst pain imaginable), obtained by guided interview by a blinded Acute Pain Service assessor.

• Time to first rescue analgesia

  Up to 24 hours after surgery

• Quality of Recovery-15 (QoR-15) score

  24 +/- 2 hours after surgery

Study Arms (2)

MTP block

EXPERIMENTAL

Ultrasound-guided MTP block with ropivacaine 0.375% 20 mL single injection at T4-T5, performed under general anesthesia in the lateral decubitus position at least 15 minutes before incision. All participants also receive the same general anesthesia, ibuprofen 400 mg IV and paracetamol 1 g IV 30 minutes before wound closure, and postoperative fentanyl PCA (10 mcg/mL, demand dose 20 mcg, lockout 10 minutes, no background infusion).

Procedure: Midpoint Transverse Process to Pleura (MTP) block

ESP block

EXPERIMENTAL

Ultrasound-guided ESP block with ropivacaine 0.375% 20 mL single injection at T4-T5, performed under general anesthesia in the lateral decubitus position at least 15 minutes before incision. All participants also receive the same general anesthesia, ibuprofen 400 mg IV and paracetamol 1 g IV 30 minutes before wound closure, and postoperative fentanyl PCA (10 mcg/mL, demand dose 20 mcg, lockout 10 minutes, no background infusion).

Procedure: Erector spinae plane (ESP) block

Interventions

Midpoint Transverse Process to Pleura (MTP) block PROCEDURE

Performed under general anesthesia in the lateral decubitus position, at least 15 minutes before surgical incision. A linear transducer (10-15 MHz) is placed parasagittally 3 cm lateral to the midline at T4-T5, and the transverse process and pleura are identified. The midpoint between the posterior edge of the transverse process and the pleura is determined. A 22G echogenic needle is advanced in-plane from cranial to caudal until the tip reaches the midpoint. After 1 mL normal saline confirms fascial separation, ropivacaine 0.375% 20 mL is injected in increments with intermittent aspiration every 5 mL. Correct placement is confirmed by fascial spread and pleural displacement on real-time ultrasound. Performed by a consultant anesthesiologist (regional analgesia).

Also known as: MTP Block

MTP block

Erector spinae plane (ESP) block PROCEDURE

Performed under general anesthesia in the lateral decubitus position, at least 15 minutes before surgical incision. A linear transducer (10-15 MHz) is placed parasagittally 3 cm lateral to the midline at T4-T5, and the transverse process and the erector spinae muscle are identified. A 22G echogenic needle is advanced in-plane from caudal to cranial until the tip lies beneath the erector spinae muscle, just above the surface of the transverse process. A 1 mL normal saline injection produces the lift sign (erector spinae muscle lifted off the transverse process), then ropivacaine 0.375% 20 mL is injected gradually. Performed by a consultant anesthesiologist (regional analgesia).

Also known as: ESP block

ESP block

Eligibility Criteria

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

You may qualify if:

• Adult patients scheduled for elective video-assisted thoracoscopic surgery (VATS) at RS Ngoerah
• Age 18-65 years
• ASA physical status I-III
• Body mass index 18-30 kg/m2
• Able to communicate well in Indonesian, understand the use of the Numerical Rating Scale, and complete the QoR-15 questionnaire
• Willing to participate and has signed written informed consent

You may not qualify if:

• Contraindication to regional anesthesia
• Allergy to the drugs used (ropivacaine, fentanyl, paracetamol and/or ibuprofen)
• Chronic chest pain for more than 2 months before surgery
• Unable to be assessed with the Numerical Rating Scale and unable to operate the PCA device

Sponsors & Collaborators

• Udayana University: lead

Study Sites (1)

RS Ngoerah

Denpasar, Bali, 80113, Indonesia

RECRUITING

MeSH Terms

Conditions

Pain; Pain, Postoperative

Interventions

Dental Occlusion; Parapsychology

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Dentistry; Dental Physiological Phenomena; Digestive System and Oral Physiological Phenomena; Behavioral Sciences; Behavioral Disciplines and Activities

Study Officials

• Tjokorda Gde Agung Senapathi, Professor

  Udayana University

  STUDY CHAIR

• Putu Herdita Sudiantara, Sp.An-TI

  Udayana University

  STUDY DIRECTOR

Central Study Contacts

Lalu Reza Aldira Akbar, MD

CONTACT

+6281337871680; aldeeraakbar@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: Participants receive the block after induction of general anesthesia and are unaware of the block type. All outcomes are assessed by the Acute Pain Service team, who are blinded to allocation. The block operator (consultant anesthesiologist) opens the sealed opaque randomization envelope and performs the block according to allocation, but does not assess outcomes. The block operator is not masked.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Resident Physician, Anesthesiology

Model Details: Two-arm, parallel-group randomized trial with block randomization. Each participant receives either an ultrasound-guided MTP block or an ultrasound-guided ESP block (ropivacaine 0.375% 20 mL, single injection, T4-T5) after induction of general anesthesia.

Study Record Dates

• First Submitted: October 5, 2026
• First Posted: October 9, 2026
• Study Start: June 4, 2026
• Primary Completion: September 3, 2026
• Study Completion: October 4, 2026
• Last Updated: October 9, 2026

Record last verified: 2026-10

Data Sharing

• IPD Sharing: Will not share

Locations

ID (1)