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

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

Interventions

PROCEDURE

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

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.

PROCEDURE

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

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%.

Sponsors & Collaborators

• Sana Klinikum Offenbach

  lead OTHER

Principal Investigators

• Haitham Mutlak, Prof. Dr. · Department of Anesthesiology, Intensive Care Medicine and Pain Therapy at Sana Klinikum Offenbach

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2026-05-04

Primary Completion

2027-04-30

Completion

2027-05-03

Countries

• Germany

Study Locations