This study will compare two different methods of pain management in patients undergoing video-assisted thoracoscopic surgery (VATS). One group will receive a combination of spinal morphine, nerve block, and dexmedetomidine, while the other group will receive a nerve block and dexmedetomidine without spinal morphine. All patients will receive standard pain medications after surgery. The purpose is to see if adding spinal morphine improves pain control and recovery after surgery.
This is a single-center, prospective, randomized, double-blind clinical trial evaluating the efficacy of intrathecal morphine in combination with serratus anterior plane block (SAPB) and dexmedetomidine infusion for postoperative analgesia in patients undergoing elective video-assisted thoracoscopic surgery (VATS). Eligible patients are ASA I-II, aged 18-70 years, with BMI \< 35 kg/m². Patients will be randomized into two groups using a computer-generated sequence. The intervention group will receive intrathecal morphine (200 µg) in addition to SAPB and dexmedetomidine, while the control group will receive SAPB and dexmedetomidine alone. The primary outcome is postoperative pain scores (VAS) within the first 24 hours. Secondary outcomes include opioid consumption, quality of recovery, and incidence of side effects.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
52
200 µg morphine sulfate, single-dose via L3-L4, 27G Sprotte spinal needle, prior to induction.
Ultrasound-guided unilateral SAPB at end of surgery with 30 mL 0.25% bupivacaine.
Loading dose 0.5 µg/kg over 15 minutes, then 0.5 µg/kg/h continuous infusion intraoperatively.
Ataturk University
Erzurum, Turkey (Türkiye)
RECRUITINGAtaturk University
Erzurum, Turkey (Türkiye)
RECRUITINGQuality of Recovery-15 (QoR-15) Score
The Quality of Recovery-15 (QoR-15) questionnaire is a validated 15-item instrument that assesses patient-centered postoperative recovery, including pain, physical comfort, emotional state, and overall wellbeing. The total score ranges from 0 to 150, with higher scores indicating better recovery.
Time frame: Measured 24 hours after surgery
Time to First Rescue Opioid
Duration (in hours) from the end of surgery to the first administration of rescue opioid (intravenous tramadol) when the Visual Analog Scale (VAS) pain score exceeds 4.
Time frame: Within 24 hours postoperatively
Postoperative Pain Scores (VAS)
Postoperative pain intensity will be evaluated using the Visual Analog Scale (VAS), a 10-cm line ranging from 0 (no pain) to 10 (worst imaginable pain). Both active (movement) and passive (rest) VAS scores will be recorded at 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, and 24 hours after surgery. Higher scores indicate more severe pain.
Time frame: From postoperative hour 2 to hour 24.
Total Opioid Consumption
Cumulative opioid consumption (including PCA tramadol, subcutaneous morphine, and rescue IV tramadol) within 24 hours postoperatively, reported in mg.
Time frame: 24 hours postoperatively
Intraoperative Complications
Occurrence of bradycardia, hypotension, or other anesthesia-related intraoperative adverse events.
Time frame: During surgery
Postoperative Adverse Effects
Incidence of nausea, vomiting, pruritus, respiratory depression, or other opioid-related side effects during the first 24 hours postoperatively.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: 24 hours postoperatively
Serum Interleukin-6 (IL-6) Level
Serum IL-6 levels (pg/mL) will be measured to evaluate the systemic inflammatory response associated with surgical stress.
Time frame: Preoperatively and at 24 hours postoperatively
Neutrophil-to-Lymphocyte Ratio (NLR)
The neutrophil-to-lymphocyte ratio (NLR) will be calculated to evaluate postoperative inflammatory status and its correlation with pain intensity and functional recovery.
Time frame: Preoperatively and at 24 hours postoperatively
Serum C-reactive Protein (CRP) Level
Serum CRP levels (mg/L) will be measured to assess postoperative systemic inflammation.
Time frame: Preoperatively and at 24 hours postoperatively.
Platelet-to-Lymphocyte Ratio (PLR)
The platelet-to-lymphocyte ratio (PLR) will be calculated as a marker of postoperative inflammation and its correlation with pain level and recovery quality.
Time frame: Preoperatively and at 24 hours postoperatively.
Lymphocyte-to-Monocyte Ratio (LMR)
The lymphocyte-to-monocyte ratio (LMR) will be calculated to assess systemic immune response in relation to postoperative recovery.
Time frame: Preoperatively and at 24 hours postoperatively.
Systemic Immune-Inflammation Index (SII)
The systemic immune-inflammation index (SII) will be calculated as platelet × neutrophil / lymphocyte, providing an integrated indicator of postoperative inflammatory and immune status.
Time frame: Preoperatively and at 24 hours postoperatively.