This study will be conducted after institutional ethical committee approval and Clinical Trials Registry India (CTRI) registration. Written informed consent of patient will be taken.

Standard monitoring with electrocardiography, non-invasive blood pressure, capnography, a multi-gas analyser, and peripheral oxygen saturation will be performed on all patients in the operating room. Mechanical ventilation will be achieved using a pressure-controlled mode to maintain end-tidal carbon dioxide at 35 to 40 mm Hg. Depth of anaesthesia will be controlled during surgery using end-tidal sevoflurane and maintaining the sevoflurane concentration (0.8-1MAC). M-TAPA will be administered bilaterally by a single anaesthesiologist after the induction of general anaesthesia before the surgical procedure.

Anaesthesia induction and endotracheal intubation will be    performed intravenously using propofol 2 mg/kg, fentanyl 1-2 Âµg/kg, and atracurium 0.5 mg/kg. Anaesthesia will be maintained with sevoflurane and oxygen and nitrous oxide.

M-TAPA technique- M-TAPA will be performed bilaterally by a single anaesthesiologist, as described by Tulgar et al. Following the tracheal intubation and before the surgical procedure, transversus abdominis, internal oblique, and external oblique muscles were identified with a high-frequency (12 MHz) linear probe on the costochondral angle in the sagittal plane under ultrasound guidance at the 10th costal margin. A deep angle will be given to the costochondral angle at the edge of the 10th costa with the probe in the sagittal direction to view the lower surface of the costal cartilage in the midline. A 21-G, 80-mm block needle was inserted in the cranial direction using the in-plane technique and the needle tip will be moved to the posterior aspect of the 10th costal cartilage. It will be noted that the needle tip never crossed the cranial edge of the 10th costal cartilage and 25 mL of 0.25% bupivacaine will be injected into the lower surface of the chondrium. The same process will be repeated for the other side.

The primary objective of the study will be to evaluate the need for first rescue analgesia in the first postoperative 24 h in patients with and without M-TAPA block. Pain severity will be measured using CHEOPS scale and FLACCS scale. Both will be recorded postoperatively at 0 and 2, 6, 12 hrs. If FLACC score above 4 rescue analgesic will be given.

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