Thoracotomy is known as one of the most painful surgical procedures, with up to 65% of patients developing chronic post-thoracotomy pain syndrome (PTPS), and approximately 10% experiencing pain that significantly impacts quality of life. Video-assisted thoracoscopic surgery (VATS) has become increasingly common over the past decade and offers reduced postoperative pain, morbidity, and length of hospital stay compared to open thoracotomy. However, VATS can still cause moderate to severe postoperative pain and a high risk of chronic pain. Optimizing analgesia after VATS remains critical. With advances in ultrasound technology, several regional anesthesia techniques such as serratus anterior plane block (SAPB), erector spinae plane block (ESPB), and thoracic epidural analgesia (TEA) have shown comparable efficacy. In 2023, Tulgar et al. described the serratus posterior superior intercostal plane block (SPSIPB), which demonstrated dermatomal coverage from C3 to T10. This randomized controlled trial aims to compare the analgesic efficacy of SPSIPB and SAPB in patients undergoing VATS procedures.
BMI < 35 kg/m² Patients with ASA scores I, II, III
Patients who do not want to be included in the study Psychiatric and neurological disease with blurred consciousness Patients with ASA > 3 BMI > 35 kg/m² Abnormality in coagulation parameters History of allergy to local anesthetic drugs Infection at the injection site Patients whose surgical procedure time exceeds 150 minutes
Parallel
SAPB
Other interventionUltrasound guided serratus anterior plane block will be performed.
SPSIPB
Other interventionUltrasound guided serratus posterior superior intercostal plane block will be performed.
Morphine consumption in the first 24 hours postoperatively
Morfin consumption in the first 24 hours after surgery
Pain density
NRS scores (Numeric rating scale; 0: no pain, 10: severe pain) in the first 24 hours after surgery
Quality of recovery
QR15 scores
Nausea and vomiting
Nausea and vomiting scores in the first 24 hours (verbal rating scale; 0= none, 1= nausea, 2= gagging, 3= vomiting)
shoulder pain
postoperative shoulder pain;shoulder pain will be evaluated as present/absent
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