Intercostal Nerve Block
What are the intercostal nerves and why are intercostal nerve blocks helpful?
Intercostal nerves are small nerves that travel along the lower border of the ribs. Irritation and inflammation of these nerves can cause pain in the mid-back, chest wall and abdominal area. Intercostal nerve blocks can be helpful in reducing pain from a variety of conditions that cause rib pain or chest wall pain, such as post-herpetic neuralgia.
General Pre-injection Instructions:
Be sure to inform our staff if you have an allergy, particularly to iodine. If you will be receiving sedation, you should NOT eat the morning of the procedure. If not receiving sedation, patients can eat a light meal a few hours before the procedure. If a patient is an insulin dependent diabetic and receiving sedation, they may need to change their morning dose of insulin to account for not eating the morning of the procedure. Patients may take their routine medications (i.e., high blood pressure and diabetic medications, e.g. Glucophage).
Patients should continue to take pain medications or anti-inflammatory medications the day of their procedure. If a patient is on Coumadin or another blood thinner, they should notify the staff so an appropriate plan can be made for stopping the medication before the procedure. We generally recommend that a driver should accompany the patient and be responsible for getting them home.
What happens during the procedure?
The patient is placed on the procedure table on their stomach so the physician can best visualize the lower margin of the ribs where the intercostal nerves pass, using x-ray guidance. The skin is scrubbed using antibacterial soap. Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a very small needle using x-ray guidance near the intercostal nerve. Then, a small amount of numbing medicine (local anesthetic) and sometimes an anti-inflammatory (steroid) is injected.
What happens after the procedure?
After the procedure, the patient is taken to the recovery room. An x-ray of the chest will also be ordered to make sure that the procedure has not cause a small deflation of the lungs (pneumothorax). Patients are then asked to report the percentage of pain relief. Patients may return to their normal activities on the day of the procedure.