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Rectointercostal Fascial Plane Block With or Without Modified Thoracoabdominal Plane Block for Postoperative

Volkan Özen1, Engin İhsan Turan2, Bahadir Çiftçi3,4

  • 1From the Department of Anesthesiology, Prof Dr Cemil Taşçioğlu City Hospital, Istanbul, Turkey.

A&A Practice
|June 18, 2026
PubMed

Insights

Ultrasound-guided rectointercostal fascial plane blocks, alone or with M-TAPA, offer effective opioid-sparing pain management for pediatric abdominal surgery. These techniques provide excellent analgesia, reducing the need for opioids in young patients.

Area of Science:

  • Pediatric Anesthesiology
  • Regional Anesthesia
  • Pain Management

Background:

  • Postoperative pain in pediatric abdominal surgery has somatic and visceral components.
  • Opioid-sparing strategies are crucial for managing pediatric pain.
  • Multimodal analgesia is essential for effective pain control in children.

Purpose of the Study:

  • To evaluate the efficacy of ultrasound-guided rectointercostal fascial plane block for pediatric abdominal surgery.
  • To assess the combination of rectointercostal block and modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) in pediatric patients.
  • To explore opioid-sparing analgesia strategies in pediatric abdominal procedures.

Main Methods:

  • Case report of two pediatric patients undergoing abdominal surgery.
  • Ultrasound-guided rectointercostal fascial plane block performed unilaterally or bilaterally.
  • Combination of rectointercostal block with M-TAPA in one case.
  • Assessment of pain using FLACC (Face, Legs, Activity, Cry, Consolability) scores and opioid requirements.

Main Results:

  • Bilateral rectointercostal block provided sustained low FLACC scores and no opioid requirement in a patient undergoing Meckel diverticulum excision.
  • Combined M-TAPA and rectointercostal blocks resulted in excellent analgesia without rescue opioids in a patient undergoing retroperitoneal tumor excision.
  • Both techniques demonstrated feasibility and effectiveness in the reported cases.

Conclusions:

  • Ultrasound-guided rectointercostal fascial plane block is a feasible and effective opioid-sparing analgesic technique for pediatric abdominal surgery.
  • Combined rectointercostal block and M-TAPA can provide excellent analgesia in complex pediatric abdominal procedures.
  • These regional anesthesia techniques represent valuable components of multimodal analgesia for pediatric surgical patients.

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