SPSIP Block vs SAP Block for Post-VATS Pain

Summary

Comparison of Superior Serratus Posterior Intercostal Plane Block and Serratus Anterior Plane Block for Pain Management Following Video-Assisted Thoracoscopic Surgery: A Randomized Prospective 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, there is no randomized controlled trial directly comparing it with SPSIPB. Therefore, this planned study aimed to evaluate whether SPSIPB is noninferior to SAPB for postoperative analgesia and to compare the postoperative analgesic efficacy of the two techniques performed under ultrasound guidance.

Conditions

• Applying SPSIP Block With Ultrasound Guidance After VATS
• Applying SAP Block With Ultrasound Guidance After VATS
• Comparing the Effectiveness of Blocks Using Postoperative NRS Pain Scores

Interventions

PROCEDURE

Serratus Anterior Plane Block (SAPB) group

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 20 mL of 0.25% ropivacaine was injected. The needle was then withdrawn until it reached the myofascial plane formed by the serratus anterior and latissimus dorsi muscles, and a hydrodissection technique was used to confirm that the needle was located in the intended myofascial space. After negative aspiration, 10 mL of 0.25% ropivacaine was injected.

PROCEDURE

Serratus posterior superior intercostal plane block

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.

Sponsors & Collaborators

• Firat University

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

TRIPLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-01-20

Primary Completion

2026-08-01

Completion

2026-08-01

Countries

• Turkey (Türkiye)

Study Locations