Recto-intercostal fascial plane block: A scoping review

Abstract

Background

The recto-intercostal fascial plane block (RIFPB) is a novel ultrasound-guided regional anesthesia technique intended to provide analgesia for the anterior thoracoabdominal wall, particularly the subxiphoid and epigastric regions. Unlike established modalities such as thoracic epidural, transversus abdominis plane (TAP) block, or parasternal intercostal plane block (PIPB)—which are limited by side-effect profiles or incomplete cranial/epigastric spread—RIFPB seeks to target intercostal nerves in a safe and relatively avascular plane. Early case reports suggest potential benefits in patients undergoing sternotomy or upper abdominal surgery, but the evidence base remains preliminary.

Objectives

This scoping review aimed to systematically map and synthesize the current evidence on RIFPB, focusing on its anatomical basis, technical feasibility, clinical applications, dermatomal coverage, and safety considerations.

Eligibility criteria

Eligible sources included cadaveric studies, letters, case reports, case series, abstracts, and conceptual reports describing the anatomical spread, technique, or clinical utility of RIFPB. Only studies published in English were considered. Randomized controlled trials were not identified.

Sources of evidence

A comprehensive search was conducted across PubMed, Embase, Scopus, Cochrane Library, and Google Scholar from database inception to June 2025. Grey literature, including professional society proceedings (ASRA, ESRA) and preprint servers (medRxiv, Research Square), was also screened.

Charting methods

Records were imported into EndNote, then transferred to Rayyan.ai for screening. Duplicates were removed manually. Title/abstract and full-text screening were independently performed by two reviewers, with discrepancies resolved by consensus or a third reviewer. A standardized data extraction form (Microsoft Excel) was used to capture study characteristics, technique details, dermatomal coverage, and outcomes.

Results

Ten publications were included: six case reports/letters, one cadaveric study, one conceptual description, one case series, and one conference abstract. Most clinical reports described use in cardiac surgery, typically in combination with a PIPB for sternotomy analgesia. Two reports involved upper abdominal surgery. The cadaveric study demonstrated consistent dye spread between T6–T9, supporting the anatomical rationale for epigastric analgesia. Clinical studies variably reported sensory involvement from T5–T11, although testing methods were inconsistent. No randomized controlled trials were identified. Across available evidence, RIFPB was consistently described as technically feasible, safe, and free from major complications, including in pediatric patients.

Conclusions

RIFPB appears to be a feasible, anatomically rational, and potentially valuable adjunct to the existing repertoire of anterior thoracoabdominal wall blocks. Its ability to provide epigastric analgesia positions it as complementary to PIPB and TAP blocks, particularly in cardiac and upper abdominal surgery. However, the current evidence is limited to preliminary, case-based reports without standardized outcome measures or comparative data. Future research should focus on prospective, randomized trials with validated pain scores, opioid consumption metrics, and safety endpoints to establish efficacy and generalizability. Until then, RIFPB should be regarded as an experimental but promising technique rather than a replacement for established modalities.