After laparoscopic sleeve gastrectomy, patients have pain due to surgery. Different
analgesic methods are preferred for pain relief. One of the methods used for this purpose
is regional anesthesia. Modified thoracoabdominal plane block-perichondrial approach
(M-TAPA) and transversus abdominis plane (TAP) block are also plan blocks used for this
purpose. TAP block is formed by injecting local anesthetic into the neurofacial space
between the transversus abdominis muscle and the internal oblique muscle through the
Petit triangle in the lumbar region. TAP block creates dermatomal sensory block in the
lower, lower thoracic and upper lumbar abdominal afferents. It is thought that the
modified thoracoabdominal plane block-perichondrial approach (M-TAPA), which is a block
frequently used in upper abdomen surgeries in recent years, can provide effective
analgesia in LSG surgeries. M-TAPA block is created by administering local anesthetic
between the transverse abdominis muscle and the internal oblique muscle with a single
injection under the costal cartilage under ultrasound guidance. With M-TAPA, analgesia
can be provided in thoracic 4 and thoracic 11-12 dermatomes.

Blocking of T4-12 nerve endings may be required in LSG surgeries, since gastric
innervation and thoracic inlets are located in the upper abdomen dermatomes. In studies,
the use of M-TAPA block in upper abdominal surgeries may be effective in the management
of analgesia in participants. In this study the investigators aimed that, compression in
terms of efficiency and complications TAP and M-TAPA blocks, who is undergoing
laparoscopic sleeve gastrectomy. The investigators aims to examine whether M-TAPA block
provides more effective analjesia than TAP block in upper abdomen surgeries, and whether
there is any difference in terms of nausea- vomiting and need for additional analgesics.
After obtaining ethical committee approval (12.01.2023/1), between January 26, 2023, and
May 15, 2024, 60 patients undergoing laparoscopic sleeve gastrectomy with American
Society of Anesthesiologists (ASA) II-III status provide informed consent. Participants
who are planing to receive M-TAPA block defines as Group M-TAPA, and those who receive
TAP block defines as Group TAP, with 30 patients in each group.The participitans will be
observed for postoperative 24 hours with numeric rating score (NRS), postoperative
nausea-vomiting score (PNVS) and in terms of need for additional analgesic dose.