This study aims to determine the minimum effective volume of bupivacaine required for the serratus posterior superior intercostal plane (SPSIP) block in patients undergoing video-assisted thoracoscopic surgery (VATS). The SPSIP block is an ultrasound-guided regional anesthesia technique used to provide postoperative pain relief after thoracic surgery.
Using a stepwise dose-adjustment method, the volume of local anesthetic will be increased or decreased based on the effectiveness of the block in each patient. The main outcome of the study is to identify the volume that provides effective pain control in 50% of patients. The results may help optimize pain management while minimizing drug exposure.
Age 18 years or older
Scheduled for elective video-assisted thoracoscopic surgery (VATS)
American Society of Anesthesiologists (ASA) physical status I-III
Planned to receive ultrasound-guided serratus posterior superior intercostal plane block for postoperative analgesia
Refusal to participate in the study
Known allergy or contraindication to local anesthetics
Infection at the block injection site
Coagulation disorders or anticoagulant therapy contraindicating regional anesthesia
Sequential
Ultrasound-Guided Serratus Posterior Superior Intercostal Plane Block
Other interventionUltrasound-guided serratus posterior superior intercostal plane block performed prior to general anesthesia in patients undergoing video-assisted thoracoscopic surgery (VATS). A 0.5% bupivacaine solution is injected, and the volume is adjusted in 2 mL increments according to the Dixon up-and-down sequential allocation method to determine the median effective volume (ED50).
Median Effective Volume (ED50) of 0.5% Bupivacaine for Successful SPSIP Block
The median effective volume (ED50) of 0.5% bupivacaine required to achieve successful postoperative analgesia following ultrasound-guided serratus posterior superior intercostal plane block, determined using the Dixon up-and-down sequential allocation method.
Postoperative Pain Scores (NRS)
Numerical Rating Scale (NRS) pain scores ranging from 0 to 10, where 0 represents no pain and 10 represents the worst imaginable pain, assessed at rest and during movement at 0, 1, 2, 4, 8, 12, and 24 hours after surgery.
Postoperative Morphine Consumption via Patient-Controlled Analgesia (PCA)
Total cumulative morphine dose administered through patient-controlled analgesia (PCA) within the first 24 postoperative hours, measured in milligrams. Higher values indicate increased analgesic requirement.
Postoperative Adverse Effects
Incidence of opioid- and block-related adverse effects including nausea, vomiting, pruritus, dizziness, hypotension, respiratory depression, and local complications at the block site.
Quality of Recovery Score (QoR-15)
Quality of Recovery assessed using the 15-item Quality of Recovery questionnaire (QoR-15), with scores ranging from 0 to 150, where higher scores indicate better postoperative recovery.
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Bursa City Hospital
Lead sponsor
Ulusoy, Emre, M.D.
Collaborator
