Rhomboid Intercostal and Subserratus Plane Block vs Erector Spinae Plane Block in Video-Assisted Thoracoscopic Surgery

Video-assisted thoracoscopic surgery (VATS) can be very painful and may lead to complications such as prolonged stays in intensive care, thromboembolic complications due to lack of early mobilization, chronic acute pain, and delirium if adequate analgesia is not provided. Therefore, using thoracic epidural, paravertebral, or regional blocks as part of multimodal analgesia is recommended to provide effective pain relief.

This study aims to compare the effects of the erector spinae plane block (ESP) and rhomboid intercostal subserratus plane block (RISS) on postoperative analgesia and the improvement of respiratory parameters in patients undergoing VATS. These two techniques may have different analgesic profiles with respect to somatic and visceral pain.

The primary objective is to evaluate the incidence of chest tube-site somatic pain at postoperative hour 2. Secondary objectives include the incidence of visceral pain, total analgesic consumption in the first 24 hours postoperatively, assessing resting and dynamic pain scores, triflow performance, complications, and length of hospital stay.

• ESP block group (Procedure): ESP blocks are performed for patients undergoing VATS.
• RISS block group (Procedure): RISS blocks are performed for patients undergoing VATS.

Primary outcomes

• Incidence of chest tube-site somatic pain [At postoperative hour 2]: Proportion of participants with localized pain at the chest tube insertion site, elicited by palpation or chest tube manipulation. Somatic pain was recorded as present or absent.

Secondary outcomes

• Dynamic pain score [Postoperative first 24 hours.]: Postoperative pain scores during coughing and deep breathing are measured on a 11 cm scale, where "0" indicates no pain and "10" indicates the worst pain ever.
• Opioid consumption [Postoperative first 24 hours.]: Total opioid consumption within the first 24 hours in the postoperative period.
• Resting pain score [Postoperative first 24 hours.]: Postoperative pain scores during rest are measured on a 11 cm scale, where "0" indicates no pain and "10" indicates the worst pain ever.
• Pulmonary functions [Postoperative first 24 hours.]: Pulmonary functions are assessed using Triflow performance. Postoperative Triflow numbers (whether 1, 2, or 3 balls can be raised) for the patients are recorded.
• Complications [From block administration to hospital discharge.]: Complications regarding regional blocks and surgery (such as hematoma, pulmonary complications) are recorded.
• Hospital stay time [From surgery to hospital discharge.]: The length of hospital stay is recorded.
• Incidence of visceral pain [At postoperative hour 2]: Proportion of participants reporting deep, poorly localized intrathoracic pain not confined to the incision or chest tube insertion site. Pain was recorded as present or absent.

Sex: All, ages: 18 Years to 80 Years

Inclusion Criteria:

* Patients who will undergo VATS
* Who agrees to participate
* American Society of Anesthesiologists (ASA) physical status I, II, and III
* Elective surgery
* Age between 18 and 80 years

Exclusion Criteria:

* Local anesthetic allergy
* Who disagrees to participate
* ASA physical status IV and V
* Emergency surgery
* Hemorrhagic disease
* Thoracic vertebrae deformity
* Thoracic vertebrae surgery

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