The intercostal nerves run under the ribs. An intercostal nerve block is an injection of steroid and anesthetic (numbing) medications around the nerves located below each rib.
Am I a candidate for an Intercostal Nerve Block?
Your Pain Doctor along with your referring physician will determine if you are appropriate for an epidural injection. Usual conditions treated by intercostal nerve blocks include pain around the ribs or chest wall, pain from rib fractures, shingles, pain from scar tissue around the chest wall following thoracic surgery.
What are the benefits of an Intercostal Nerve Block?
Epidurals have the ability to reduce inflammation in a localized fashion thereby reducing pain and helping to reset the pain pathways in your body. They have the added benefit of targeting medication release directly to the region or area of pain.
How long does the procedure take?
The entire procedure will take approximately 10 minutes.
Where is the procedure performed?
It is typically done in an office or surgical suite using fluoroscopy.
How is the procedure performed?
Typically an IV is started so that the anesthesiologist can administer sedating medication to make you comfortable. Your doctor will typically identify the area he will be injecting using the X-ray machine, and then provide some local numbing medication (Lidocaine) before placement of the needle. The needle is advanced using x-ray guidance along the inferior margin of the rib and “walked” off the rib. Needle position may be confirmed with the injection of contrast dye, as well as the X-ray images. The dye will not be used if there is an allergy. Once needle placement is assured, the therapeutic solution is injected.
What if I am afraid of needles?
Typically patients with needle phobia do just fine with sedation to help relax them. They also typically will have little to no memory of the actual procedure.
Is it painful?
Generally no, your doctor will do everything possible to minimize and discomfort during the procedure. This may require sedation and is typically achieved with the numbing medication (lidocaine).
What are the risks and side effects?
The procedure is generally safe. However, with any procedure or medications there are potential risk, complications, and side effects. Whenever a needle is introduced through the skin there is risk of infection, bleeding, and soreness. For this reason, all our procedures are performed under sterile technique, and a careful history is taken to ensure any risks of bleeding are minimized. On occasion, one may develop numbness do to extensive spread of the local anesthetic. Very rarely the lung can be punctured resulting in something called a pneumothorax. Please contact your doctor or go to the emergency room if you develop difficulty breathing, catching your breath, shortness of breath. Fortunately, side effects are exceedingly rare.
What should I expect after the block?
Immediately after the injection, you may feel that your pain may be gone or less. This is due to the local anesthetic injected. This will last only a few hours. Your pain may return and you may have a sore spot for a day or two. This is due to the mechanical process of needle insertion. You should start noticing a more lasting pain relief starting the third day or so.
How many intercostal nerves can be blocked at once?
Many times only one nerve is blocked, especially if it is an easily identified single nerve. Other times, several nerves are blocked.
Will the intercostal nerve blocks help me?
It is challenging to predict if an injection will help you or not. Patients with new onset pain tend to respond much better then those with chronic pain. Typically the 1st injection serves as a test treatment.
Who should not have an Intercostal Nerve Block?
Anyone who is allergic to any of the medications being injected, if you are on blood thinning medications, if you have an active infection, if you have active and poorly controlled heart disease.