Recto-intercostal fascial plane block (RIFPB) is a recently described ultrasound-guided regional anesthesia technique proposed for analgesia of the anterior thoracoabdominal wall. First described by Tulgar et al. in 2023, RIFPB was conceptualized to complement parasternal intercostal plane block (PIPB), especially for analgesia in regions not adequately covered by traditional parasternal techniques— such as the subxiphoid, epigastric region, and sites of anterior chest or abdominal drains placed following cardiac or upper abdominal surgery [1].

The technique involves advancing a needle under ultrasound guidance to the fascial plane between the rectus abdominis muscle (RAM) and the costal cartilages of the 6th–7th ribs, approximately 3–4 cm lateral and caudal to the xiphoid process. Local anesthetic is injected into this plane, targeting the anterior and lateral cutaneous branches of the lower thoracoabdominal nerves, predominantly T6–T9 [1,2].

Although initially introduced in the context of sternotomy-related pain, clinical interest has extended to broader thoracoabdominal applications. The anatomical rationale is supported by cadaveric dye studies showing anterior spread along relevant dermatomes. [2,3]. However, existing evidence is limited to letters, case reports, and small series, with no published prospective trials to date.

Compared with thoracic epidural and transversus abdominis plane (TAP) block, RIFPB offers a simpler, more peripheral approach with lower risk of sympathectomy, hypotension, or visceral injury. Its anatomical target is relatively avascular, making it theoretically safer in anticoagulated or high-risk patients. In addition, RIFPB appears to provide more consistent cranial analgesia than TAP block, and potentially fills the gap left by parasternal blocks when extended epigastric or drain-site analgesia is needed [4,5].

Interest has also arisen in combining RIFPB with PIPB, sometimes referred to as the “Medipol combination,” to achieve multimodal anterior chest and epigastric coverage in post-sternotomy patients [6]. Such combined approaches reflect a growing trend toward tailoring regional anesthesia strategies to specific surgical incisions and drain sites, rather than relying on a single block. Nevertheless, the evidence remains embryonic, with a lack of standardized methodology, injectate volumes, or outcome reporting across studies.

Given the novelty of RIFPB and the fragmented nature of the evidence, a scoping review is appropriate to systematically map and summarize the available literature. Unlike a systematic review, which typically addresses a focused clinical question, a scoping review allows exploration of anatomical, technical, and clinical aspects, highlights variability in reported methods and outcomes, and identifies knowledge gaps requiring further study. The objective of this scoping review is to chart the current evidence on RIFPB with respect to (i) anatomical validation and injectate spread, (ii) technical approaches and block characteristics, (iii) clinical applications across surgical populations, and (iv) reported outcomes and safety.