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?
Provision of written informed consent
Adults (≥ 18 years of age)
Elective video-assisted thoracoscopic surgery (VATS) for pulmonary resection (e.g., lobectomy, segmentectomy, wedge resection)
Lack of informed consent
Language barrier
Pregnancy or breastfeeding
Known allergy to local anesthetics used in the study
Parallel
Anesthesiological, Ultrasound-Guided "Erector Spine Plane Block" (ESPB)
Procedure/SurgeryThe 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.
Surgical, Thoracoscopically-Guided "Intercostal Nerve Block" (ICNB)
Procedure/SurgeryThe 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%.
Assessment of the postoperative analgesic consumption within the first 24 hours after surgery
Postoperative analgesic consumption is recorded during the first 24 hours after surgery. Both total opioid consumption and use of non-opioid analgesics (e.g., metamizole, paracetamol) are documented.
Assessment of the postoperative pain perception using the Numeric Rating Scale (NRS) pain scale
Postoperative pain is assessed using a standardized pain questionnaire (NRS Numeric Rating Scale Scale, Range: Generally 0-10, where 0 is "no pain" and 10 is "worst imaginable pain") administered by the hospital's anesthesiology pain service at predefined time points: 1 hour, 2 hours, 12 hours, and 24 hours after surgery. The anesthesiology pain service remains blinded to the intervention performed.
Duration of the chest wall block
Time required to perform the chest wall block, defined as the period from initial needle insertion to completion of the full local anesthetic dose administration.
Incidence of postoperative nausea and vomiting (PONV)
Incidence of complications
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