Objective The aim of this study is to compare the analgesic efficacy of bilateral
subcostal transversus abdominis plane (TAP) and modified thoracoabdominal (M-TAPA) blocks
in reducing intraoperative opioid consumption and postoperative analgesic needs in
patients undergoing laparoscopic sleeve gastrectomy (LSG).

Study Design This will be a retrospective study conducted at Haseki Training and Research
Hospital between January and November 2024. The study will include patients with a BMI
greater than 35 kg/m², aged between 18 and 65, who are scheduled to undergo LSG surgery.
Patients will receive either a subcostal TAP or M-TAPA block before surgery. Data will be
collected from patient records, including intraoperative opioid usage, postoperative
analgesic consumption, and pain scores (NRS) assessed at rest and during activity in the
first 24 hours. Secondary outcomes will include mobilization times and incidence of
postoperative nausea and vomiting (PONV).

Study Procedures Patients who meet the inclusion criteria will be included in the study,
and data will be retrospectively reviewed. Intraoperative hemodynamic data, surgical
duration, and total opioid consumption will be collected from anesthesia records.
Postoperative analgesic use and pain scores will be assessed from nurse documentation and
medical records. Patients with incomplete data or pre-existing chronic pain conditions
will be excluded.

Outcome Measures

- Primary Outcome: Comparison of the analgesic efficacy of M-TAPA and subcostal TAP
blocks during intraoperative and postoperative periods (first 24 hours).

- Secondary Outcomes: Resting and active NRS pain scores, mobilization times,
incidence of nausea and vomiting, and complications related to the block procedures.