Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 05 02 1560 1560 Ahmed Ezzat Department of Anesthesia and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Fahmy Lateef Department of Anesthesia and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Mona Hosny Department of Anesthesia and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Rana Abdelhalim Department of Anesthesia and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Rasha Ali Department of Anesthesia and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 2026 01 30 2026 02 28 Background: Poorly controlled acute pain after abdominal surgery originates from somatic pain in the abdominal wall and is associated with multiple adverse postoperative outcomes, including psychological distress, cardiopulmonary complications, prolonged hospitalization, delayed bowel recovery, increased analgesic requirements, and a higher risk of chronic pain. The objective is the evaluation of the postoperative analgesic effectiveness of oblique subcostal and posterior techniques for ultrasound-guided Transversus Abdominis Plane (TAP) block in hepatectomy. Methods: Forty patients aged 40–60 years (ASA class II–III) scheduled for hepatectomy at Ain Shams University Hospitals were randomly assigned to two groups of 20. One group received general anesthesia plus an ultrasound-guided oblique subcostal TAP block with 30 ml of a solution containing bupivacaine 0.25%, lidocaine, magnesium, and dexamethasone. The second group received general anesthesia and combined subcostal and posterior TAP blocks using the same solution via both routes, totaling 60 ml without exceeding safe dose limits. Results: Patients who received only the subcostal TAP blocks experienced significantly lower pain scores during the first 24 hours after surgery and required fewer analgesics than those who received combined subcostal and posterior TAP blocks. Conclusion: Compared with the subcostal TAP block alone, the combined oblique subcostal and posterior TAP block provided better postoperative pain control and reduced analgesic requirements after hepatectomy under general anesthesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/1560