Comparison of Deep Serratus Anterior Plane Block and Superficial Serratus Anterior Plane Block

Study Overview
=================
Brief Summary
-----------------
Video-assisted thoracic surgery (VATS) has become a common procedure in thoracic surgery. Severe postoperative pain may be encountered in patients undergoing VATS. Analgesic methods such as thoracic paravertebral block (TPVB), intercostal block, serratus anterior plane block (SAPB) and erector spina plane block (ESPB) are widely used for VATS. Among these methods, ultrasound (US) guided TPVB is the most preferred method. In recent years, the frequency of application of plane blocks as a component of multimodal analgesia has been increased. ESPB and SAPB are some of them. There are two techniques for SAPB application. In Deep SAPB (DSAPB) application, local anesthetic agent is given under the serratus anterior muscle. In the Superficial SAPB (SSAPB) application, the local anesthetic agent is given above the serratus anterior muscle. The mechanisms of regional analgesia techniques used after thoracic surgery operations are also different from each other. Therefore, in this study, the analgesic efficacy of two different methods, DSAPB and SSAPB, will be compared.

Official Title
-----------------
Comparison of the Effects of Ultrasound-Guided Deep Serratus Anterior Plane Block and Superficial Serratus Anterior Plane Block on Postoperative Acute Pain in Patients Undergoing Video-Assisted Thoracoscopic Surgery

Conditions
-----------------
Pain, Postoperative, Serratus Anterior Plane Block, Thoracic Surgery, Video-Assisted

Intervention / Treatment
-----------------
* Procedure: Two different blocks with same local anesthetic volume


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Age between 18 and 65 years American Society of Anesthesiologists physical status I-II-III Body mass index between 18-30 kg/m2 Patients undergoing elective video assiste thoracoscopic surgery Exclusion Criteria: Patient refusing the procedure History of chronic analgesic therapy History of local anesthetic allergy Infection in the intervention area Patients with bleeding disorders Emergency surgery

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Deep Serratus Anterior Plane Block<br>Following the visualization of the anatomical structures, the nerve block needle will be advanced via the in-plane technique beneath the serratus anterior muscles until the interfascial space was reached. After hydrodissection with 2 ml normal saline, 20 ml 0.25% bupivacaine will be injected into the area. | Procedure: Two different blocks with same local anesthetic volume<br>* Deep serratus anterior block and superficial serratus anterior plane block will be applied to the patients under real-time ultrasound guidance.<br>|
| Active Comparator: Superficial Serratus Anterior Plane Block<br>Following the visualization of the anatomical structures, the nerve block needle will be advanced via the in-plane technique above the serratus anterior muscles until the interfascial space was reached. After hydrodissection with 2 ml normal saline, 20 ml 0.25% bupivacaine will be injected into the area. | Procedure: Two different blocks with same local anesthetic volume<br>* Deep serratus anterior block and superficial serratus anterior plane block will be applied to the patients under real-time ultrasound guidance.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Scores | Pain will be assessed at rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). Pain assessment will be done at 1st, 2nd, 4th, 8th, 16th, 24th and 48th hours after surgery. | 48 hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morphine Consumption | Morphine consumption for 24 hours will be recorded | 24 hours after surgery | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Postoperative Pain, Serratus Anterior Plane Block, Video-Assisted Thoracic Surgery, VATS