Overview

This study evaluates respiratory recovery as a multidimensional construct using clinically relevant and measurable parameters, including LUS, diaphragmatic excursion, oxygen requirement, and PPCs.

The investigators hypothesize that bilateral ESP block improves postoperative respiratory function compared with EOIP block following open hepatic surgery. The investigators further hypothesize that this improvement is mediated, in part, by superior analgesia.

Eligibility

Inclusion Criteria:

• Adult patients aged 18-75 years
• Adult with American Society of Anesthesiologists (ASA) physical status I-III
• Scheduled for elective hepatic surgery via upper abdominal incisions will be eligible.
• All participants will be required to understand the Numeric Rating Scale (NRS) and provide informed consent.

Exclusion Criteria:

• Patient refusal
• Coagulopathy (INR\>1.4 or platelet count\<8 x 104)
• Contraindications to fascial plane blocks
• Infection at the puncture site
• Known allergy to study medications
• Chronic opioid use or chronic pain syndromes
• Severe chronic respiratory failure requiring home oxygen or noninvasive ventilation
• Pregnancy
• Body mass index\>40 kg/m²
• When ultrasound imaging will be deemed unreliable
• Emergency surgery
• Hemodynamic instability
• Reoperation during the same hospital admission.
• Patients scheduled preoperatively for elective postoperative mechanical ventilation or planned ICU intubation.