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Background and Aims Regional anesthesia methods in LSG operations are very important in preventing many postoperative complications and in pain management. Modified thoracoabdominal nerves block through a perichondrial approach (M-TAPA), defined by Tulgar et al., targets a wider area covering the T5-T12 dermatomes, providing effective analgesia in upper abdominal surgeries. This study compares the analgesic efficacy of subcostal transversus abdominis plane (TAP) block and modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) in patients undergoing laparoscopic sleeve gastrectomy (LSG).Methods In this retrospective, single-center study, 41 patients who underwent LSG between January–November 2024 and received either a bilateral subcostal TAP or M-TAPA block preoperatively were analyzed. Data on intraoperative opioid use, postoperative analgesic consumption, and numeric rating scale (NRS) pain scores were collected. Exclusion criteria included chronic pain, preoperative opioid use, and incomplete records. All surgeries were performed using a standardized technique.Results Demographics, surgical characteristics, and block application details were similar between groups. No significant difference was observed in intraoperative remifentanil requirements. In the first 24 postoperative hours, both groups showed comparable consumption of NSAIDs, paracetamol, and tramadol. NRS scores at rest and during activity, as well as postoperative nausea and vomiting incidence, were also statistically similar. No block-related complications were reported.Conclusions Both block techniques provided effective analgesia during and after LSG. Although M-TAPA theoretically covers a wider dermatomal area (T5-T12), this did not translate into superior clinical outcomes. The lack of significant difference may stem from the limited surgical area or the retrospective design. Stable hemodynamics and low postoperative analgesic needs in both groups suggest adequate pain control regardless of block type. Subcostal TAP and M-TAPA blocks are equally effective and safe for analgesia in LSG. Despite M-TAPA’s broader anatomical coverage, neither method showed clear superiority. Larger, prospective studies incorporating patient-reported outcomes are warranted to determine the optimal technique for clinical practice.Abstract EP045 Figure 1EnrollmentAbstract EP045 Table 1Demographic characteristicsAbstract EP045 Table 2Intraoperative opioid consumptionsAbstract EP045 Table 3Postoperatif pain assessment