To compare efficacy of modified thoracoabdominal nerve block through perichondrial approach versus oblique subcostal transversus abdominis plane block for postoperative pain management.

Total laparoscopic hysterectomy (TLH), though a minimally invasive gynaecological procedure, is frequently associated with significant postoperative pain,particularly within the first 24–48 hours. Pain after TLH is multifactorial, involving somatic pain from trocar insertion, visceral pain from uterine and pelvic manipulation, and referred shoulder pain from diaphragmatic irritation caused by pneumoperitoneum.Effective management of this pain is important not only for patient comfort but also to facilitate early ambulation, reduce hospital stay, and lower the risk of complications such as thromboembolism and chronic postoperative pain.

Although opioid-based treatments are traditionally effective, their undesirable side effects such as nausea, vomiting, respiratory depression, sedation, pruritus, constipation, ileus, opioid dependency, etc. can interfere with recovery and extend hospital stays.In recent years, newer blocks such as oblique subcostal transversus abdominis plane block (OSTAP) and modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) have been found to effectively cover T6-L1 and T7-T12 dermatomal regions respectively, making them suitable options for pain control in laparoscopic gynaecological surgeries.

Therefore, this study is needed to evaluate and compare the analgesic efficacy of the M-TAPA and OSTAP blocks as part of a multimodal analgesia approach for pain management in patients undergoing total laparoscopic hysterectomy.