Video-assisted thoracic surgery (VATS) is widely performed for the management of various thoracic pathologies and is generally associated with reduced surgical trauma compared with open thoracotomy. Nevertheless, patients may still experience considerable postoperative pain, which can adversely affect respiratory function, mobilization, and recovery. Various regional analgesic techniques have been incorporated into multimodal pain management strategies for VATS, including thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), intercostal nerve block, serratus anterior plane block (SAPB), rhomboid intercostal block (RIB), and serratus posterior superior intercostal plane block (SPSIPB). Among these approaches, ultrasound-guided TPVB has traditionally been regarded as a reference regional analgesic technique. More recently, interfascial plane blocks have gained increasing attention because of their technical simplicity and favorable safety profile. RIB and SPSIPB are two novel interfascial plane blocks that may provide effective postoperative analgesia following thoracic surgery. The present study aims to compare the analgesic efficacy of RIB and SPSIPB in patients undergoing VATS and to evaluate their impact on postoperative pain outcomes.
Patients undergoing elective VATS
Patients aged 18-75 years
Patients with ASA (American Society of Anesthesiologists) class I-III
Patients who have given informed consent
Patients allergic to local anesthetics
Patients with bleeding disorders or those undergoing anticoagulant therapy
Pregnant and breastfeeding women
Patients with impaired consciousness, inability to communicate, or mental/cognitive impairment
Parallel
Rhomboid Intercostal Block
DrugRhomboid intercostal block will be applied to the patients under real-time ultrasound guidance.
Serratus Posterior Superior Intercostal Plane Block
DrugSerratus posterior superior intercostal plane block will be applied to the patients under real-time ultrasound guidance.
Surgical Pain Scores
Surgical pain will be assessed at rest and while coughing using the visual analog scale on a scale from 0mm (no pain) to 100mm (worst pain). Pain assessment will be done at 1st, 6th, 12th, and 24th hours after surgery.
Shoulder Pain Scores
Shoulder pain will be assessed at rest and while coughing using the visual analog scale on a scale from 0mm (no pain) to 100mm (worst pain). Pain assessment will be done at 1st, 6th, 12th, and 24th hours after surgery.
Intraoperative remifentanil consumption
The amount of remifentanil that patients need to maintain anesthesia during the intraoperative period will be recorded.
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