Comparison of the Analgesic Efficacy of Erector Spinae Plane Block, Serratus Anterior Plane Block, and Serratus Posterior Superior Intercostal Plane Block on Postoperative Pain in Patients Undergoing Video-Assisted Thoracoscopic Surgery
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 45
- 试验地点
- 1
- 主要终点
- Visual analogue scale (VAS) score
研究概览
简要总结
This study aimed to compare erector spinae plane block (ESPB), serratus anterior plane block (SAPB), and serratus posterior superior intercostal plane block (SPSIPB) to determine the most suitable technique for maintaining postoperative analgesia in video-assisted thoracoscopic surgeries (VATS).
详细描述
Patients were randomly allocated into three groups: ESPB, SAPB, and SPSIPB. All patients received postoperative paracetamol and dexketoprofen, and intravenous tramadol hydrochloride was administered via patient-controlled analgesia. Postoperative static and dynamic VAS scores, total tramadol consumption, side effects, and the need for additional analgesia were monitored and recorded at regular intervals. Primary outcome was VAS scores and secondary outcome was total tramadol consumption.
Block Techniques
All blocks were performed following surgical closure, prior to extubation, with the patient in lateral decubitus and the skin prepared with 10% povidone-iodine.
ESPB was performed in 15 patients. An ultrasound (USG) probe was placed in a sagittal orientation at the T5 level, 3 cm lateral to the midline, to visualize the transverse process. The trapezius, rhomboid major, and erector spinae muscles were identified. Using an in-plane technique, a needle was advanced cranio-caudally through these muscles until it reached the transverse process. After negative aspiration, 30 mL of 0.25% bupivacaine was injected deep to the erector spinae muscle.
SAPB: The latissimus dorsi and serratus anterior muscles were identified at the midaxillary line at the 4th-5th rib level in a longitudinal parasagittal orientation. A needle was advanced from caudal to cranial using an in-plane approach, first targeting the plane between the latissimus dorsi and serratus anterior, and then deep to the serratus anterior. After negative aspiration, 10 mL was injected into the superficial plane and 20 mL into the deep plane, for a total of 30 mL of 0.25% bupivacaine.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Forty-five adult patients scheduled for elective wedge resection or biopsy under VATS, classified as American Society of Anesthesiologists (ASA) physical status I-III, were enrolled after providing written informed consent.
排除标准
- •ASA class IV or higher,
- •morbid obesity (BMI > 40 kg/m²),
- •body weight ≤ 50 kg,
- •skin infection at the block site,
- •refusal to participate,
- •inability to cooperate during postoperative pain assessment,
- •conversion to open surgery,
- •preexisting pain,
- •known allergy to any study medication,
- •coagulopathy.
研究组 & 干预措施
ESP block
Erector spinae plane (ESP) block was performed in 15 patients. An ultrasound (USG) probe was placed in a sagittal orientation at the T5 level, 3 cm lateral to the midline, to visualize the transverse process. The trapezius, rhomboid major, and erector spinae muscles were identified. Using an in-plane technique, a needle was advanced cranio-caudally through these muscles until it reached the transverse process. After negative aspiration, 30 mL of 0.25% bupivacaine was injected deep to the erector spinae muscle. The block was performed unilaterally, targeting the surgical hemithorax.
干预措施: Erector Spinae Plane Block (Procedure)
SAP block
Serratus anterior plane (SAP) block was performed in 15 patients. The latissimus dorsi and serratus anterior muscles were identified by using USG at the midaxillary line at the 4th-5th rib level in a longitudinal parasagittal orientation. A needle was advanced from caudal to cranial using an in-plane approach, first targeting the plane between the latissimus dorsi and serratus anterior, and then deep to the serratus anterior. After negative aspiration, 10 mL was injected into the superficial plane and 20 mL into the deep plane, for a total of 30 mL of 0.25% bupivacaine. The block was performed unilaterally, targeting the surgical hemithorax.
干预措施: Serratus anterior plane block (SAP) (Procedure)
SPSIP block
The USG probe was placed 2-3 cm medial to the scapular spine to visualize the trapezius, rhomboid major, and serratus posterior superior muscles. At the level of the 2nd-3rd ribs, a needle was advanced into the plane between the serratus posterior superior muscle and the rib. After confirming negative aspiration, 30 mL of 0.25% bupivacaine was injected. The block was performed unilaterally, targeting the surgical hemithorax.
干预措施: Serratus posterior superior intercostal plane block (Procedure)
结局指标
主要结局
Visual analogue scale (VAS) score
时间窗: postoperative 24 hours
The Visual Analogue Scale (VAS) measures pain intensity. The VAS consists of a 10 cm line, with two end points representing 0 ('no pain') and 10 ('pain as bad as it could possibly be').
次要结局
- Total tramadol consumption(postoperative 24 hours)
研究者
Oguz Gundogdu
Associate Professor
Cumhuriyet University