ESPB Versus SPSIPB for Quality of Recovery After Video-Assisted Thoracoscopic Surgery

Video-assisted thoracoscopic surgery (VATS) is associated with moderate to severe postoperative pain despite its minimally invasive nature. Ultrasound-guided erector spinae plane block (ESPB) and serratus posterior superior intercostal plane block (SPSIPB) are promising regional analgesic techniques for thoracic surgery; however, evidence directly comparing their effects on postoperative quality of recovery remains limited. This prospective, randomized, double-blind controlled trial aims to compare the effects of ESPB and SPSIPB on postoperative quality of recovery, measured by the Quality of Recovery-15 (QoR-15) questionnaire at 24 hours after surgery. Secondary outcomes include postoperative pain scores, tramadol consumption, time to first rescue analgesia, rescue analgesic requirement, postoperative nausea and vomiting, patient satisfaction, length of hospital stay, block-related complications, and perioperative hemodynamic parameters.

Inclusion Criteria: * Adults aged 18-85 years. * ASA physical status I-III. * Scheduled for elective VATS under general anesthesia. * Able to understand and complete the QoR-15 questionnaire. * Written informed consent provided. Exclusion Criteria: * Refusal to participate or inability to provide written informed consent. * Known allergy or contraindication to bupivacaine, paracetamol, dexketoprofen, or tramadol. * Infection at the planned block injection site. * Coagulopathy or ongoing anticoagulant therapy precluding regional anesthesia. * Severe hepatic or renal insufficiency. * Chronic opioid use or chronic pain requiring regular analgesic treatment. * Previous thoracic surgery on the operative side. * Pregnancy or breastfeeding. * Cognitive impairment, psychiatric illness, or language barrier preventing completion of the QoR-15 questionnaire. * Body mass index (BMI) \>35 kg/m². * Conversion from VATS to thoracotomy. * Failed or incomplete regional block.