Background: Transversus abdominis plane (TAP) blocks reduce postoperative opioid requirements by providing additional analgesic benefits as components of multimodal analgesia regimens. This study compared the postoperative analgesic efficacy of lateral versus posterior approaches to the TAP block in patients undergoing obstetric and gynecological surgery.

Methods: This prospective observational study included 80 female patients (aged 18-50 years, ASA I-II) scheduled for elective obstetric and gynecological surgery under general anesthesia. Patients were divided into two groups (n=40 each): Group L (lateral TAP block with 0.2% ropivacaine) and Group P (posterior TAP block with 0.2% ropivacaine). Postoperative pain was assessed using the Visual Analog Scale (VAS) at 0, 2, 4, 6, 12, and 24 hours. Secondary outcomes included postoperative opioid requirements and hemodynamic changes.

Results: Patients in Group P exhibited significantly lower VAS scores at all assessment time points compared to Group L (p<0.001). Group L required significantly more postoperative opioids compared to Group P (82.5% vs. 50%; p=0.002). The mean number of opioid doses in 24 hours was significantly higher in Group L (2.58±0.84) compared to Group P (0.83±0.98) (p<0.001). However, the time to first analgesic request showed no significant difference between groups (6.79±4.73 vs. 6.70±3.28 hours; p=0.934). Hemodynamic parameters were comparable between groups with no statistically significant differences.