Rectointercostal Fascial Plane Block With or Without Modified Thoracoabdominal Plane Block for Postoperative Analgesia in Pediatric Abdominal Surgery: A Two-Case Report

Postoperative pain after pediatric abdominal surgery includes both somatic and visceral components, making opioid-sparing strategies desirable. We report two pediatric cases in which ultrasound-guided rectointercostal fascial plane block was used alone or combined with modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) as part of multimodal analgesia. In a 9-year-old undergoing laparoscopic Meckel diverticulum excision, a bilateral rectointercostal block provided sustained low FLACC (Face, Legs, Activity, Cry, Consolability) scores with no opioid requirement. In a 5.5-year-old undergoing retroperitoneal tumor excision, combined M-TAPA and rectointercostal blocks resulted in excellent analgesia without rescue opioids. These observations suggest effective, feasible, opioid-sparing analgesia in selected pediatric abdominal procedures.