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Intercostal Nerve Block

An intercostal nerve block is a block of the nerves that lie underneath the lower edge of each rib. For certain types of injuries, e.g., rib fractures, nerve injuries to the chest wall, postoperative pain along the rib nerves ("intercostal nerves"), injection of a small amount of local anesthetic can significantly diminish pain.

How long does this procedure take?

The injection takes only a few minutes. Please allow about an hour for the procedure; this will include talking to your doctor before the procedure, signing the informed consent, positioning in the room, and observation by the recovery room nurse afterwards. 

What medicines are injected?

The diagnostic injection consists of local anesthetic only. If the diagnostic injection is successful, your doctor may discuss with you the option of injecting other medications that could last for several weeks, months, or even permanently. The longer lasting injections may include steroids (methylprednisolone or triamcinolone) or dilute phenol (a "neurolytic", resulting in longer-lasting block of the nerve).

Will the injection hurt?

Our procedures begin by injecting a local anesthetic through a small needle. It feels like a little pinch and then a slight burning as the local anesthetic starts numbing the skin. After the skin is numb, the procedure needle feels like a bit of pressure at the injection site. If you experience any pain during the procedure, your doctor will inject more local anesthetic as needed.

Will I be "put out" for this procedure?

No.  This procedure is done under local anesthesia.

How is the procedure performed?

The procedure is done with you lying on your stomach with your arms stretched upward. Your blood pressure and oxygenation will be monitored. In addition to your doctor and the x-ray technician, there will be a nurse or medical assistant in the room at all times if you have any questions or discomfort during the procedure. The skin over the affected rib(s) is cleaned with antiseptic solution and then the procedure is done. A very small, slightly blunt needle is carefully placed under the rib, contrast agent is injected and its path is verified by x-ray. Then, the medicine is injected.

What should I expect after the injections?

After the injection, your pain may be gone or considerably less. You will be kept in the recovery room for a short period for observation.

What should I do after the procedure?

We advise patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Your recovery room nurse will advise you about applying ice to the site.

Can I go back to work the same day?

You should be able to return to work the same day. Your doctor or recovery room nurse will discuss this with you.

How long does it last?

The long-term effect of the medication cannot be predicted. For the diagnostic injection, the duration is only for the effectiveness of the local anesthetic. If other agents (steroids or phenol) are used, the block may last for weeks, months, or permanently.

How many injections do I need?

This will vary with each patient; your doctor will discuss this with you.

Can I have more than one injection?

If the first injection is successful but the pain returns, you may be eligible for another injection. Your doctor will discuss this with you.

How will I know if the injection will help?

It is difficult to predict how helpful injections will be. Patients who have the symptoms described above will do well.

Since there are several pain generators for back and chest wall pain, the degree of response will vary widely. Patients with recent onset of pain may respond much better than ones with longstanding pain.

What are the risks and side effects?

This procedure has few risks.  Commonly encountered side effects include: increased pain from the injection site (usually temporary), inadvertent puncture of the "sack" containing spinal fluid (made cause headaches), infection, bleeding, nerve damage, or no relief from your pain.

A rare complication that may occur with this block is a pneumothorax, which is the collapse of a lung.  If you develop shortness of breath up to a few hours after the procedure, call 911 immediately.

Who should not have this procedure?

The following patients should not have this injection: if you are allergic to any of the medications to be injected, if you are on a blood-thinning medication (e.g. coumadin, injectable heparin), or if you have an active infection going on.

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