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Intercostal Peripheral Nerve Block

Intercostal nerve blocks are a minimally invasive, non-surgical treatment. These nerve blocks can help in the diagnosis of persistent chest, abdominal, and flank pain that is not responsive to oral medications. In addition, this pain management technique can also provide therapeutic relief by reducing pain signals originating from these nerves.

Common scenarios where this treatment may be utilized include pain either before or after chest wall surgery, chest wall trauma, chronic pain after thoracic surgery, post-herpetic neuralgia, chronic abdominal pain persistent after abdominal surgery, chronic pain after breast surgery (mastectomy), and pain from metastatic disease to the ribs.

How It Works

To increase accuracy and safety, an intercostal nerve block is performed with x-ray guidance or ultrasound. 

  • You will be asked to lie on your stomach. 
  • Your mid and lower back will be cleaned with an antiseptic, and a sterile drape will be placed.
  • Your physician will anesthetize your skin with numbing medicine.
  • Next, bony landmarks easily visible under live x-ray guidance will be targeted to help facilitate safe placement of the needle.The intended target is immediately below the rib where the intercostal nerve sits.
  • A local anesthetic and a steroid (cortisone) will be administered in close proximity to the nerve to block signals from reaching the brain.
  • The cortisone serves as a potent anti-inflammatory under the assumption the intercostal nerve is inflamed or irritated.
  • The needle is then flushed and withdrawn, and a dressing is placed over the point of needle entry.

Risks

While this procedure is considered safe, there can be risks, side effects and the possibility of complications. The most common side effect is temporary pain at the injection site. Other less common risks include bleeding, infection, or injection into blood vessels. The most concerning although uncommon side-effect is unintended puncture of the lung, which lies in close proximity to the ribs. X-ray guidance or ultrasound to provide visualization of the targeted structures significantly minimizes risk and improves accuracy.