What is an intercostal nerve block and when are they indicated?
Intercostal Nerve Blocks numb up the nerves that run underneath the lower edge of each
rib. They are typically used when an injury to the nerve or associated rib has occurred.
This is most frequently in the setting of rib fractures or chest surgery, but may also be
used in the treatment of post-herpetic neuralgia (pain after shingles).
What should I expect during an intercostal nerve block?
During the procedure, you will be placed facedown on the X-ray table. The doctor will
map out the area of your pain and use X-rays to make sure the correct ribs are being
blocked. Then, your skin will be cleansed and the area will be sterilely draped. Your
doctor will then numb up the skin overlying the planned injection site(s) with a pinch and
burn. Next, a needle will be placed with X-ray guidance to contact the lower edge of the
rib and walk just slightly forward to where the nerve lives. The doctor will confirm
placement with a small amount of X-ray contrast, and then inject numbing medicine with
or without steroid around the nerve.
What are the risks of intercostal nerve blocks?
As with any procedure that breaks the skin, there is a small risk of bleeding or infection.
For this type of injection, patients do not need to stop any blood thinners or aspirin as
clinically significant bleeding is extraordinarily rare. Other risks include not helping the
pain, worsening the pain, injury to the artery or vein that runs with the nerve (very rare),
and puncturing the lung. The doctor uses X-ray guidance to perform the procedure as
safely as possible and uses a variety of techniques to minimize any complications.
What should I expect after intercostal nerve blocks?
You may notice that the skin overlying the ribs and extending down to the front of the
chest or abdomen may be numb – this is normal. You will be given a Pain Diary to keep
track of how the injection affected your pain so that you can discuss it with your doctor at
the next visit. It is important that you also pay attention to whether or not you feel the
level above or level below needs to be blocked at another time – i.e., you get excellent
pain relief but there is an area above/below the numb area that is still painful.