Intercostal Nerve Block

The intercostal nerves are tiny nerves that run along the lower edge of the ribs. When these nerves become inflamed or irritated, it can result in pain in the mid-back, chest wall, and abdominal region. Intercostal nerve blocks are beneficial in managing pain originating from various conditions that induce rib or chest wall pain, such as post-herpetic neuralgia.

Before Injection Guidelines: It’s crucial to notify our staff if you have any allergy, specifically to iodine. If you are scheduled for sedation, you must refrain from eating on the morning of the procedure. Patients who are insulin-dependent diabetics and are to receive sedation may need to adjust their morning insulin dosage due to the fasting. Patients can continue their regular medication routine, such as high blood pressure and diabetic medications like Glucophage.

Patients should persist in taking their pain or anti-inflammatory medication on the procedure day. If a patient is on Coumadin or a similar blood thinner, they should inform the staff so an appropriate plan can be developed to cease the medication before the procedure. Generally, we advise that a driver accompanies the patient to ensure their safe return home.

During the Procedure: The patient is positioned on their stomach on the procedure table to allow the physician the best view of the lower rib margin, where the intercostal nerves are located, using x-ray guidance. The skin is thoroughly cleaned with antibacterial soap. The physician then applies a numbing medicine to a small area of skin, which might sting for a few seconds. Once the numbing medicine has had time to take effect, the physician guides a very small needle using x-ray towards the intercostal nerve. Then, a small volume of numbing medicine (local anesthetic) and occasionally an anti-inflammatory (steroid) are injected.

Post-procedure: After the procedure, the patient is moved to the recovery room. A chest x-ray is also ordered to verify that the procedure hasn’t resulted in a minor deflation of the lungs (pneumothorax). Patients are then asked to quantify their percentage of pain relief. Patients can usually resume their regular activities on the same day of the procedure.