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.
Anintercostal nerve blockis 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.
Thefirst 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.
FAQs
Risks / Benefits
Intercostal nerve blocks are usually successful at providing temporary pain relief. But the duration of pain relief can vary from person to person.
Where is the best place to give an intercostal nerve block? ›
The best needle insertion site for ICNB is the angle of the rib, about 7 cm lateral to the midline in adults. The ideal angle of entry into the subcostal groove is about 20 degrees cephalad.
What to expect after an 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.
What is the technique for intercostal nerve block? ›
Technique. An intercostal nerve block can be performed with the patient in a sitting, prone, or lateral decubitus position and the intended block region upward. Sedation is optional and can be achieved with a combination of a benzodiazepine, a short-acting narcotic such as fentanyl, and/or ketamine.
How successful are nerve blocks? ›
The effects of the injection are usually quick, but nerve blocks are often just a temporary fix. Some people may benefit from one injection, while others need multiple. Some people don't experience any effects from the block and may require different treatment methods to manage their symptoms.
What is the most common complication of intercostal nerve block? ›
Are there any side effects caused by an intercostal nerve block?
- The most common side effect is pain at the site of injection.
- A pneumothorax (collapsed lung) is extremely rare, but it is a serious condition.
Commonly encountered side effects are increased pain from the injection (usually temporary), inadvertent puncture of the “sack” containing spinal fluid (may cause headaches), infection, bleeding, nerve damage, or no relief from your usual pain.
What should you not do after a nerve block? ›
Don't sign legal documents or do anything that requires attention to detail until you recover. It takes time for the medicine's effects to completely wear off. Don't drive or operate any machinery for at least 24 hours. Wait until the medicine wears off and you can think clearly and react easily.
Why do I feel worse after a nerve block? ›
Because of the volume of the injection, if that injection does get right next to the nerve, the expansion of the tissue from the volume of the injection can actually cause a localized stress or stretching of the nerve, worsening the inflammation and pain rather than making it better.
What does intercostal nerve pain feel like? ›
Intercostal neuralgia pain will typically follow a distribution along the affected dermatome or in a band-like pattern, often perceived as pain, tightness, stabbing, aching, and/or burning along the rib(s), chest and/or back, and/or upper abdomen.
The nerve block will result in quick relief that only is intended to last 8 hours. In some cases, the blocks provide long term relief. The ablation procedure may take 10-14 days to reach maximal effectiveness.
What kind of doctor treats intercostal neuralgia? ›
This is the specialization of the neurologist. In some cases, complex therapy is carried out together with a cardiologist, a therapist (pulmonologist, gastroenterologist). Specialists carry out diagnostics, and also prescribe drugs for the treatment of intercostal neuralgia.
How long does a rib nerve block last? ›
The nerve block will result in quick relief that only is intended to last 8 hours. In some cases, the blocks provide long term relief. The ablation procedure may take 10-14 days to reach maximal effectiveness.
Can intercostal nerve pain go away? ›
Depending on the cause, intercostal neuralgia may go away in a few weeks to months with treatment. It is also possible for symptoms to resolve on their own without treatment. Some people, however, will continue to experience chronic pain for the long term.
How long does a Neeve block take to work? ›
Usually a single nerve block takes 5-10 minutes to do. It takes another 15-20 minutes to start working fully. We always make sure the block is working before you go into the operating room. Again, you will be given some sedation medicine to help you relax when we do the block.
