NCT07524673

Comprasion of SPSIP and Rhomboid Intercostal Plan Blocks on VATS

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

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 40 (actual)
• Sponsor: Cumhuriyet University · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

This study aimed to compare rhomboid intercostal plane block and serratus posterior superior intercostal plane block (SPSIPB) to determine the most suitable technique for maintaining postoperative analgesia in video-assisted thoracoscopic surgeries (VATS).

Detailed description

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. All blocks were performed unilaterally, targeting the surgical hemithorax. Postoperative Analgesia and Assessments Twenty minutes before extubation, all patients received 1 g IV paracetamol and 50 mg IV dexketoprofen. In the recovery room, patient-controlled analgesia (PCA) with IV tramadol hydrochloride was initiated (4 mg/mL concentration, 10 mg bolus, 20-minute lockout, maximum 3 boluses/hour). Postoperative NRS scores (static at rest and dynamic during movement or coughing) were recorded at 0, 1, 2, 6, 12, 18, and 24 hours. The first NRS assessment (0 hour) was performed when the patient achieved an Aldrete score of 9. If NRS ≥ 4, an additional 50 mg IV tramadol was administered. Additional analgesic consumption was recorded. Side effects such as nausea, vomiting, and pruritus were documented.

Conditions

• Postoperative Pain Management

Interventions

Type	Name	Description
PROCEDURE	RIB BLOCK	30 mL of 0.25% bupivacaine was injected deep to the rhomboid intercostal spinal block.
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.

Timeline

• Start date: 2025-06-12
• Primary completion: 2025-06-12
• Completion: 2025-07-01
• First posted: 2026-04-13
• Last updated: 2026-04-15

Locations

1 site across 1 country: Turkey (Türkiye)