USG-Guided TAPA vs RIFB Block for Postoperative Analgesia in Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy (LC) can cause moderate-to-severe postoperative pain from visceral, referred shoulder, and incisional sources. Multimodal analgesia is recommended, but opioids carry significant side effects. Ultrasound-guided interfascial plane blocks offer a safe alternative. The Modified Thoracoabdominal Nerve Block through Perichondrial Approach (M-TAPA) blocks T5-T12 dermatomes, while the Recto-Intercostal Fascial Plane Block (RIFPB) provides sensory blockade across the upper anterolateral abdomen. This study compares the postoperative analgesic efficacy of bilateral M-TAPA versus bilateral RIFPB in patients undergoing LC.

Inclusion Criteria: * Age 18-65 years * ASA physical classification I-II * BMI \< 35 kg/m² * Scheduled for elective laparoscopic cholecystectomy due to cholelithiasis * Able to use and understand the NRS pain scoring system * Able to use and understand the QoR-15 scale * Able to communicate in Turkish * Provided written informed consent Exclusion Criteria: * Refusal to participate in the study * BMI ≥ 35 kg/m² * ASA physical classification III-V * Age \< 18 or \> 65 years * Allergy to local anesthetics or study analgesics * Pregnancy or breastfeeding * Inability to use or understand the NRS pain scoring system or QoR-15 scale * Inability to communicate in Turkish * Uncontrolled anxiety disorder * Alcohol or drug dependency * Neuromuscular or peripheral nerve disease * High-dose opioid use within 3 days prior to surgery * Widespread chronic pain * Diabetes mellitus * Hepatic or renal insufficiency * Coagulation disorders or anticoagulant use * Infection at the block needle insertion site * Concurrent second surgical procedure alongside laparoscopic cholecystectomy * Previous abdominal surgery or trauma history * Conversion from laparoscopic to open surgery * Technical problems with the PCA device * NRS score \> 7 for four consecutive hours despite multimodal analgesia * Planned postoperative non-extubation * Termination of surgery before completion for any reason