Investigating the Analgesic Efficacy and Ease of Perfomance of Modified Throracoabdominal Plane Block and Comparing it With Erector Spinea Plane Block in Laparacopic Sleeve Gasterctomy Surgeries

Interest in surgical weight loss interventions continues to rise in the face of what has been dubbed the obesity epidemic. The most popular of these weight loss interventions is laparoscopic sleeve gastrectomy, which has proven to reduce morbidity and mortality of morbidly obese patients. The aim of effective perioperative pain management extends beyond increased patient comfort and includes reduced recumbency period, enhanced recovery, reduced hospital stay, and lowers postoperative complication rates. Effective postoperative pain management has traditionally relied on multimodal strategies that combine systemic opioids, non-opioid medications, and regional anesthesia. Despite their efficacy, opioids are associated with a range of undesirable effects, such as nausea, vomiting, sedation, pruritus, and respiratory depression, which may impede early mobilization and recovery. These concerns have accelerated the adoption of ultrasound-guided regional anesthesia techniques as part of Enhanced Recovery After Surgery (ERAS) protocols, delivering superior pain control with fewer systemic adverse effects.

Inclusion Criteria: * Patients from both sexes. * 18 to 60 years old. * ASA physical status II-III scheduled for laparoscopic sleeve gastrectomy. * Patients with BMI (40-50) kg/ m2 Exclusion Criteria: * Patient Refusal * Lack of patient cooperation. * Patients with any contraindication to regional nerve blocks as coagulopathy or infection at site of injection * Patients with anatomical abnormalities at site of injection * Patients with known hypersensitivity to bupivacaine, or any of the used drugs. * Patients with pre-existing neurological disorder * Patients with chronic pain syndromes including fibromyalgia, complex regional pain syndrome (CRPS), or chronic pain requiring long-term opioid or neuropathic pain medications. * Patients with history of long-acting opioids, steroids, anticonvulsants perioperatively.