Intercostal Nerve Blocks

An intercostal nerve block is an injection of an anesthetic, and often steroids, in the intercostal nerve in order to relieve pain. This injection inhibits pain signals and reduces inflammation, thereby decreasing the pain involved.

Intercostal blocks are administered through the ribs in the thoracic region. Typically, the procedure is performed during chest or abdominal surgery, though it is also done as an outpatient procedure for acute pain.

The intercostal nerve is responsible for carrying pain messages from the muscles, bones, and skin to the brain. By blocking certain regions of this nerve, physicians can diagnose where the pain is originating and inhibit further pain. The first intercostal nerve block is normally used for diagnostic purposes only, with subsequent intercostal nerve blocks used to block pain signals.

Intercostal nerve blocks are also a relatively safe procedure for patients with little risk of side effects. Physicians can easily access the intercostal nerve by injecting the area between two ribs where the nerve is located. When successful, the procedure also frees patients from the side effects of opioid medications.

Patients are injected with an anesthetic, and often steroids, in the intercostal nerves. The block itself only takes a few minutes. The physician first applies a local anesthetic to the area. With the patient sitting on his or her side or back, the physician then administers the injection into the intercostal nerves.

After the procedure, the patient is normally monitored for a few minutes and then allowed to return home. If there is no pain relief in the weeks following the procedure, a new treatment plan must be considered. If the treatment was successful, the patient will begin to feel pain relief immediately after the surgery, due to the local anesthetic, and another level of pain relief three to five days after the procedure once the steroid component has taken effect.

While intercostal nerve blocks can be very helpful for relieving pain, it is difficult to predict exactly how and if they will help. The first injection is often used to diagnose the actual area in pain. When successful, the patient may experience pain relief for weeks or months after the procedure, or the relief may become permanent.

More often, patients return for repeat injections to treat the pain after the effects of the initial intercostal nerve block wears off. A permanent ablation can eventually be performed to provide long-term pain relief. Patients with acute, recent pain often respond better to intercostal nerve blocks than patients experiencing chronic pain.

Intercostal nerve blocks can be used to treat:

• Pain in the chest associated with herpes zoster or shingles
• Post-operative pain in the chest or abdomen
• Chronic pain after a mastectomy
• Pain from a rib fracture
• Pain related to scar tissue formation after surgery
• Pain associated with metastatic cancer to the ribs

In general, intercostal nerve blocks are extremely safe. There may be some temporary discomfort from the needle insertion, however, the local anesthetic should prevent this. The most common side effect is temporary pain at the injection site. More serious side effects include infection, bruising, bleeding, or worsening of these symptoms.

Since intercostal nerve blocks are performed in the area surrounding the lungs, there is a relatively small chance that the lung could be damaged, resulting in a collapsed lung. If patients experience shortness of breath after the procedure, they should contact their physician.