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Intercostal Nerve Blocks

An intercostal nerve block is the injection of a local anesthetic (like Novocain) in the area between two ribs where the intercostal nerve is located. An intercostal block is performed for the diagnosis and treatment of upper back, flank, or chest pain that may be neuropathic (nerve) or somatic (muscle, bone) in origin. Neuropathic pain sometimes occurs after a nerve has been damaged, such as from shingles, a previous surgical incision or metastatic cancer eroding into a nerve. Somatic pain can result from metastatic cancer to the rib bones or a previous surgical incision made through the chest wall, ribs and muscles. Temporarily blocking or disrupting painful nerve impulses associated with neuropathic pain can result in various degrees of permanent relief. If, after following a single block, you achieve partial permanent relief, a series of several blocks can be performed of which each successive block may give a greater degree of sustained relief.

Procedure Overview

You may be sitting or lying for the procedure. The area to be injected will be cleansed with an antiseptic. The doctor will place the needle into the intercostal space below the ribs and then inject the local anesthetic or cortisone preparation. After the procedure is completed, you will then be asked to turn over on your back and we will observe your vital signs for about 20 minutes and then let you go when your vital signs are stable. If the block is helpful in decreasing your pain, it will probably be repeated in 2-3 weeks.

 

Procedure Details

Will you be asleep for the procedure?

It is not necessary for you to go to sleep for this procedure; however, you will receive enough medication to keep you comfortable. How long will the procedure take? The procedure will take up to 20-60 minutes depending on how many levels need to be blocked.

Before the Procedure

Since you will be receiving medication, it is recommended that you do not eat within four or five hours before the procedure. If you are a diabetic, be sure to discuss your eating and medication schedule with your doctor. You may need to stop taking certain medications several days before the procedure. Please remind the doctor of all prescription and over- the-counter medications you take, including herbal and vitamin supplements. The doctor will tell you if and when you need to discontinue the medications. It is very important to tell the doctor if you have asthma, or any allergic reactions. The doctor may prescribe some medications for you to take before having the procedure. Tell the doctor if you develop a cold, fever, or flu symptoms before your scheduled appointment.

After the Procedure

You may experience some weakness and/or numbness in the injection area a few hours after the procedure. If so, do not engage in any activities that require lifting, balance and coordination. Do not drive for the remainder of the day. Please have an adult drive you home or accompany you in a taxi or other public transportation. Depending how you feel, you may resume normal activities and return to work the following day. Although you may feel much better immediately after the injection (due to the numbing medicine), there is a possibility your pain may return within a few hours. It may take a few days for the steroid medication to start working.

Procedure Risks

The risks, although infrequent include Pneumothorax (collapsed lung), Systemic toxic reactions, i.e., seizures, Bleeding, Hemothorax (bleeding into the chest area), Infection, Nerve damage, Worsening of symptoms. If you notice difficulty in getting your breath or pain upon inspiration, please go directly to your local emergency room and have the physician there give us a call.