Intercostal Nerve Blocks
What is an intercostal nerve block?
An intercostal nerve block is an injection of a steroid or other medication around the intercostal nerves that are located under each rib.
What is the purpose of an intercostal nerve block?
The steroid injected reduces the inflammation and/or swelling of tissue around the intercostal nerves, in between the ribs or in the chest wall. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the intercostal nerve and surrounding structures. Herpes zoster or shingles pain in the chest is commonly treated with intercostal blocks. Pain around a chest scar after a chest surgery may also respond well to intercostal blocks.
How long does the intercostal nerve block take?
The actual injection takes only a few minutes.
What is actually injected?
The injection consists of a local anesthetic and a steroid medication.
Will the intercostal nerve block hurt?
The procedure involves inserting a needle through skin and deeper tissues. So, there is some pain involved. However, the skin and deeper tissues are numbed with a local anesthetic using a very thin needle during the performance of the block.
Will I be “put out” for the intercostal nerve block?
No. This procedure is done with a small thin needle, usually without any sedation. There is local anesthetic within the injection.
How is the intercostal nerve block performed?
It is usually done with the patient lying down on one side of the chest. The side to be injected is facing up. The skin of the chest is cleaned with antiseptic solution and then the injection is carried out.
What should I expect after the Intercostal nerve block?
Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for 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 as well as initial irritation from the steroid itself. You should start noticing a more lasting pain relief starting the third day or so.
What should I do after the intercostal nerve block?
You will rest for a while in the office. Most patients can drive themselves home. We advise the patient to take it easy for several hours after the procedure. You may want to apply ice to the injected area. You can perform any activity you can tolerate.
Can I go to work to work the next day?
Unless there are complications, you should be able to return to work the next day. The most common thing you may feel is a sore spot at the injection site.
How long does the effect of the medication last?
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The steroid starts working in about 3 to 5 days and its effect can last for several days to a few months.
How many intercostal nerve blocks do I need to have?
It varies. The injections are done about one week apart and only if needed. If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have a second injection. If you respond to the injections, you may be recommended for additional injections when the symptoms return.
How many intercostal nerves can be blocked at once?
Many times only one nerve is blocked, especially if the symptoms appear to be related to an easily identified nerve. Other times, several nerves are blocked, often three levels. In this case, the worst nerve is blocked and then one nerve is done above and one nerve is done below.
Will the intercostal nerve blocks help me?
It is difficult to predict if the injection will help you or not. The patients who have recent onset of pain may respond much better than the ones with a longstanding pain. Usually the first injection is as much a test as it is a treatment. The first block will confirm that the intercostal nerves are involved in the pain and be helpful. Or the blocks will not help and the intercostal nerves will not be suspected as part of the pain.
What are the risks and side effects of intercostal nerve blocks?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is temporary pain at the injection site. Other uncommon risks involve infection, bruising, bleeding, worsening of symptoms etc. Fortunately, serious side effects and complications are uncommon. One serious side effect is a collapsed lung. This is rare, but since the needles are in close proximity to the lung, such a side effect is possible, the incidence rate is approximately 1 in 1,000.
How would I know if I had a collapsed lung?
Because of the size of the needle used, a lung usually does not collapse quickly. It may take several hours or the better part of the day, after the block, a patient feels winded or cannot seem to catch their breath or gasps for air, a collapsed lung should be suspected. Prompt transportation to the nearest Emergency Room and a chest x-ray can confirm the suspicion of a collapsed lung.
Who should not have an intercostal nerve block?
If you are allergic to any of the medications to be injected, if you are on a blood thinning medication, if you have an active infection going on, or if you have poorly controlled diabetes or heart disease, you should not have an intercostal nerve block or at least consider postponing it if postponing would improve your overall medical condition. Likewise, if you have very poor lung function and would have great difficulty with a collapsed lung, an intercostal block may not be the treatment of choice.