Erector Spinae Plane Block Versus Serratus Anterior Plane Block in VATS

NCT ID: NCT06996691

Last Updated: 2025-05-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-05-01

Study Completion Date

2025-08-15

Brief Summary

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Pain control remains challenging in patients undergoing video-assisted thoracoscopic surgery (VATS). It is advised to use a regional block to lower postoperative opioid usage. This study evaluates efficacy of Erector spinae plane (ESP) block in comparison to Serratus anterior plane block (SAP) in pain management for patients undergoing video-assisted thoracoscopic surgery(VATS).

Detailed Description

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Minimally invasive thoracic surgery (MITS) has become more common over the past decade, with the proportion of lung resections performed using this technique increasing from 16% in 2005 to 47% in 2015.

VATS is a minimally invasive procedure that allows rapid recovery compared to thoracic surgery. Patients scheduled for VATS experience moderate to severe pain following the procedure. This represents a significant burden peri-operatively as there is a strong relationship between poor pain control and the development of complications like pneumonia and atelectasis due to interference with spontaneous deep breathing \& coughing. These complications have a negative impact on functional recovery; therefore, adequate postoperative pain relief assists in improving functional outcomes \& accelerates hospital discharge.

Multimodal techniques for pain control have been recommended by The American Society of Anesthesiologists (ASA) for the management of acute postoperative pain. Traditional analgesia based on opioids have multiple adverse effects such as respiratory depression, nausea, vomiting, itching and dizziness.

SAP block was first described in 2013 by Blanco as an analgesic technique.it is proposed to block the lateral cutaneous branch of the intercostal nerve, long thoracic nerve, and dorsal thoracic nerve. The block range of the SAPB covers the incisions of video-assisted thoracoscopic surgery (VATS) and the site of the chest tube, which are often located in the antero-lateral chest wall. The local anaesthetic injection was described in two planes: the 'superficial plane' and deep plane.

An ultrasound-guided ESP block was firstly reported in 2016. The ESP block injects a local anaesthetic around the erector spinae muscle at approximately the level of the T5. It may be able to block the dorsal and ventral rami of the thoracic spinal nerves. The first report of the successful use of this procedure was in 2016; the block was used to manage thoracic neuropathic pain in a patient with metastatic disease of the ribs and rib fractures

Conditions

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Video Assisted Thoracic Surgery (VATS)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Group A: Erector spinae block group

After selecting the target transverse process for the nerve block, place the transducer in a paramedian sagittal orientation, approximately 2cm away from the midline (spinous processes), and try to vizualize the transverse process at the level of T5 Complete the nerve block with 30ml of 0.25% levobupivacaine for erector spinae block

Group Type ACTIVE_COMPARATOR

Erector Spinae Plane Block (ESPB) group

Intervention Type PROCEDURE

30ml of 0.25% levobupivacaine for erector spinae block at level of T5

group B: Serratus anterior block group

High-frequency linear transducer should be placed on the patient's midaxillary line in the transverse plane, at the level of the fifth rib. With the rib, pleural line, and overlying serratus anterior and latissimus dorsi muscles visualized.

Then, using ultrasound guidance, the needle is advanced in-plane and the local anesthetic is injected anteriorly to the rib and deep to the serratus anterior.

After opening the fascial plane, a volume of dilute local anesthetic, 30 mL of 0.25% levobupivacaine, should be gradually injected.

Group Type ACTIVE_COMPARATOR

Serratus Anterior Plane Block (SAPB) group

Intervention Type PROCEDURE

30 mL of 0.25% levobupivacaine injected anteriorly to the rib and deep to the serratus anterior at level of 5 th rib

Interventions

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Erector Spinae Plane Block (ESPB) group

30ml of 0.25% levobupivacaine for erector spinae block at level of T5

Intervention Type PROCEDURE

Serratus Anterior Plane Block (SAPB) group

30 mL of 0.25% levobupivacaine injected anteriorly to the rib and deep to the serratus anterior at level of 5 th rib

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* body mass index (BMI)=18 to 40 kg/m2

Exclusion Criteria

* Contraindications to regional anesthesia as bleeding disorders , allergy to local anesthetic or infection at block site
* pre-existing chronic pain
* history of opiate abuse
* sepsis
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ain Shams University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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faculty of medicine Ain Shams University

Cairo, , Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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abdallah M soudi, M.D.56k

Role: CONTACT

+201111228925

Facility Contacts

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abdallah soudi

Role: primary

01111228925

Other Identifiers

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FMASU MS 145/2025

Identifier Type: -

Identifier Source: org_study_id

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