The pain experienced by participants after minimally invasive chest surgery (VATS) can make it difficult for them to take deep breaths, which can lead to problems with lung function. This can cause serious problems such as lung collapse, low oxygen levels, and infections, making recovery longer and more difficult. Managing pain well after surgery is important to prevent these problems and speed up recovery. In this study, we aimed to compare two pain relief methods, Erector Spinae Plane Block (ESP) and Paravertebral Block (PVB), in participants who underwent VATS. We will look at which method causes the smallest change in lung function before and after surgery.
Both genders
Being between the ages of 18 and 65
ASA(American Society of Anesthesiologists) I-II-III
Body mass index between 19 and 30kg/m2
ASA(American Society of Anesthesiologists) IV-V
Patients who refuse to participate in the study
Patients under 18 years of age
Patients over 65 years of age
Participants aged 18-65 who will undergo video-assisted thorascopic surgery
Case-control
Prospective
Erector Spinae Plane Block (ESP)
Procedure/SurgeryThe ESP block will be administered before the VATS procedure, aiming to manage postoperative pain and minimize the impact on early lung function test (SFT) parameters. The block will be performed using standard techniques under ultrasound guidance to ensure accurate placement.
Paravertebral Block (PVB)
Procedure/SurgeryThe PVB will be administered prior to the VATS procedure, with the objective of managing postoperative pain and assessing its impact on early postoperative lung function (SFT) parameters. This block will also be performed using standard techniques and ultrasound guidance for precision.
Effectiveness on respiratory functions
All adult participants undergoing video-assisted thoracoscopic surgery (VATS) will have a preoperative pulmonary function test (PFT) conducted by an anesthetist using a portable device within the Thoracic Surgery service. The tests will be evaluated using a color-coded compliance chart: Red (Non-compliant), Yellow (Moderately compliant), Green (Compliant). The test will be repeated until compliance is achieved, with Yellow and Green results recorded. Postoperatively, PFTs will be repeated at 0, 6, 24 hours, and before discharge. The specific pulmonary function tests assessed include Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), Peak Expiratory Flow (PEF), Forced Expiratory Flow at 25-75% (FEF25-75), and the FEV1/FVC ratio. Each test will be reported as separate outcome measures. Respiratory function tests will be conducted 24 hours before surgery and then postoperatively at the specified intervals.
Effect on total narcotic analgesic consumption
After the surgery, participants will receive intravenous patient-controlled analgesia (PCA) and infusion will begin simultaneously with the end of the operation. "Morphine" was preferred as the treatment method to be used in the PCA method. In PCA preparation, 30 mg morphine is added to 100 cc of physiological saline. As the PCA protocol, 3 mg loading dose, 1 cc/hour (0.3 mg/hour) basal infusion dose, 3 cc (1 mg) bolus dose, 10-minute lockout period (maximum 2 bolus doses in 1 hour) were set. The total number of bolus doses administered by the participants on the PCA device at the end of 24 hours will be recorded and evaluated as the amount of additional opioid needed.
Effectiveness on pain scores
Postoperative pain assessment is made using visual pain scoring. Participants are asked about their resting pain 0, 1, 4, 6, 12 and 24 hours after applying a postoperative peripheral nerve block. With this method, participants rate their pain with a precise numerical value from 0 to 10. While zero(0) represents "no pain"; Ten (10) represents the opposite end of the pain continuum (e.g., "The most intense pain imaginable," "As intense pain as possible," "unbearable pain").
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