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Background and Aims Video-assisted thoracoscopic surgery (VATS) is increasingly preferred for lung resections due to its reduced postoperative pain and faster recovery compared to traditional thoracotomy. However, effective pain management remains a challenge. This study aimed to compare the analgesic efficacy of Thoracic Paravertebral Block (TPVB) and Serratus Posterior Superior Intercostal Plane Block (SPSIP) in patients undergoing VATS.

Methods In this prospective, randomized controlled trial conducted at Koç University Hospital,Istanbul,Turkey, 34 patients scheduled for VATS lung resection were randomly assigned to receive either TPVB or SPSIP in addition to standard general anesthesia. Numeric Rating Scale (NRS) scores for pain were recorded at 0, 6, 12, 24, and 48 hours postoperatively. Intravenous patient-controlled analgesia (PCA) morphine consumption was also measured over the same period.Non-parametric tests were used due to small sample size and data distribution.

Results The median NRS scores were higher initially for the Paravertebral Block group (5.00) compared to the SPISP group (3.00). The Friedman test showed significant differences in pain scores over time within both groups (Paravertebral Block: p < .001, SPISP: p = .002). The Mann-Whitney U test indicated that while the NRS scores were lower in the SPISP group at all time points, the differences were not statistically significant.Morphine consumption was significantly lower in the SPISP group (median 21.00 mg) compared to the Paravertebral Block group (median 45.50 mg, p = .012).

Conclusions SPSIP is associated with lower morphine requirements, suggesting it may provide superior pain management.Further studies are warranted to confirm these findings and to optimize postoperative analgesia in thoracic surgery.