Intercostal Nerve Blocks

The intercostal nerve is found between the ribs in the upper back. These nerves can become irritated or inflamed, often due to shingles (herpes zoster) leading to Postherpetic Neuralgia.

An intercostal nerve block is an injection of an anesthetic and/or steroid into this nerve to help relieve pain. They are frequently used to treat pain after chest or abdominal surgery, a mastectomy or a rib fracture.

The first nerve block serves as a test as well as a possible treatment for pain. If the block provides pain relief, a physician can better understand how the intercostal nerve is playing a role in a patient’s condition. If the pain is not relieved after the intercostal nerve block, other treatments may be available or it could mean something other than the intercostal nerve is causing the pain.

Preparing for Intercostal Nerve Block

Patients must avoid eating solid foods at least four hours before the scheduled procedure time. Patients can drink clear liquids such as water, coffee, tea or soda up to two hours before their procedure ( if the patient wishes to have mild sedation). If a physician has given prior authorization to take regular medications, patients can do so up to two hours before the procedure, but should drink only small amounts of water.

Bathing or taking a shower on the morning of the procedure is advisable, as well as wearing comfortable, loose clothing to the appointment.Patients should also prepare by asking a family, friend or other caregiver to drive them home after the procedure.

What Happens During Intercostal Nerve Block?

A physician will administer local anesthetic to numb the area. Patients will most often not be sedated for the procedure. Using a fluoroscope, an instrument with a tiny camera on it that projects X-ray images in real time, the physician will determine the correct placement of the needle.

Once placed, the nerve block is injected. If needed, the injection may be performed at different sites along the nerve. Patients will need to remain still since movement can make administering the nerve block difficult.

What Happens After Intercostal Nerve Block?

Patients may be sore for several days and may have some bruising. Icing the area or taking an over-the-counter pain reliever can alleviate any discomfort after injection.

For a few hours after the procedure, patients should rest or limit activity, but they can soon resume regular activity unless advised otherwise. If the pain increases or patients experience fever, chills or bleeding at the site or anything that seems unusual, they should contact the physician.

Possible Outcomes

Pain relief varies from patient to patient. Acute pain and chronic pain often respond differently to therapy, so patients should keep doctors informed concerning response to treatment.

Once it is working, the treatment can continue to provide pain relief for weeks or months. If patients respond positively to treatment, a physician may be able to repeat injections over time to continue pain relief.