Comparison of the Analgesic Efficacy of Rhomboid Intercostal Plane Block and Serratus Posterior Superior Intercostal Plane Block on Postoperative Pain in Patients Undergoing Video-Assisted Thoracoscopic Surgery

Patients were randomly allocated into two groups: RIB and SPSIPB. All patients received postoperative paracetamol and dexketoprofen, and intravenous tramadol hydrochloride was administered via patient-controlled analgesia. Postoperative static and dynamic NRS scores, total tramadol consumption, side effects, and the need for additional analgesia were monitored and recorded at regular intervals. Primary outcome was NRS 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.

RIB:Rhomboid intercostal plane block procedure is performed using a high-frequency linear ultrasound probe. First, the rhomboid and intercostal muscles are located in the area called the auscultation triangle, at the level of thoracic 4-5 o'clock. A needle, visible on ultrasound, is advanced between the rhomboid and intercostal muscles using an in-plane technique. After aspiration is performed to ensure no blood or air is present, a total of 30 ml of 0.25% bupivacaine will be injected between the two muscle planes. The rhomboid intercostal plane block creates sensory paresthesia (sensory numbness) in a dermatomal region between T3 and T9 o'clock.

SPSIPB: 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.