Serratus Posterior Superior Intercostal Plane Block

Overview

Background: Adequate pain control after video-assisted thoracoscopic surgery (VATS) remains a major clinical challenge. Traditional techniques such as thoracic epidural analgesia are effective but limited by potential complications. Interfascial plane blocks have recently gained interest as safer alternatives. The serratus posterior superior intercostal plane block (SPSIPB) is a novel regional anesthesia technique with potential benefits in thoracic surgery. Objective: The purpose of this study was to evaluate the analgesic efficacy of ultrasound-guided SPSIPB compared with subcutaneous morphine administration in patients undergoing VATS. Methods: In this prospective, randomized controlled trial, 60 patients scheduled for elective VATS were randomized into two groups: SPSIPB group (n=30) and control group receiving subcutaneous morphine (n=30). The primary outcome was postoperative pain intensity measured by the visual analog scale (VAS) at rest and during coughing. Secondary outcomes included opioid consumption, number of patient-controlled analgesia (PCA) demands, rescue analgesia requirements, and incidence of adverse effects.

Background and Rationale: Effective postoperative analgesia after thoracic surgery is essential to prevent pulmonary complications, enhance recovery, and improve patient satisfaction. Although thoracic epidural analgesia has traditionally been considered the gold standard, its use is limited due to potential complications such as hypotension, urinary retention, and technical difficulties. With the increased use of minimally invasive thoracic procedures, including video-assisted thoracoscopic surgery (VATS), safer and less invasive analgesic techniques are being explored. The serratus posterior superior intercostal plane block (SPSIPB) is a newly described regional anesthesia technique that targets the posterior thoracic intercostal nerves. Preliminary evidence suggests that SPSIPB may provide effective postoperative analgesia while minimizing procedure-related risks. Objective: The aim of this study was to evaluate the analgesic efficacy and safety of ultrasound-guided SPSIPB compared with subcutaneous morphine injection for postoperative pain management in patients undergoing VATS. Study Design: This was a prospective, randomized controlled, single-center clinical trial conducted at Gaziantep University Faculty of Medicine, Department of Anesthesiology. Sixty patients scheduled for elective VATS under general anesthesia were enrolled. After obtaining informed consent, patients were randomly allocated into two groups: SPSIPB Group (n = 30): Patients received an ultrasound-guided serratus posterior superior intercostal plane block with 20 mL of local anesthetic at the end of surgery. Control Group (n = 30): Patients received subcutaneous morphine injection according to institutional standard practice. Outcome Measures: The primary outcome was postoperative pain intensity assessed by the Visual Analog Scale (VAS) at rest and during coughing at multiple time points within the first 24 hours after surgery. Secondary outcomes included total opioid consumption within 24 hours, the number of patient-controlled analgesia (PCA) demands, the need for rescue analgesia, and the incidence of adverse events such as nausea, vomiting, respiratory depression, or block-related complications. Significance: This study will contribute to the growing evidence on interfascial plane blocks in thoracic surgery. If proven effective, SPSIPB may serve as a safe and valuable alternative to conventional analgesic methods, reducing opioid consumption and related side effects in patients undergoing VATS.