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Intercostal Nerve Block

What is an intercostal nerve block?

An intercostal nerve block (INB) involves injecting a local anesthetic, steroid or other medications around the intercostal nerves which are located beneath each rib.

What is the purpose of an intercostal nerve block?

The purpose of the steroid that is injected in an INB is to decrease inflammation and irritation around the intercostal nerves, which in turn, decreases the pain. Conditions such as Herpes Zoster, more commonly known as shingles, in the chest is commonly treated with INB’s. Pain that is caused by a chest scar or previous chest injury or broken ribs may also respond well to INB’s.

How long does the intercostal nerve block take?

INB’s are short procedures, often only taking a few minutes.

What is actually injected?

INB’s typically consist of a combination of local anesthetic and a steroid medication.

Will the intercostal nerve block hurt?

In order to minimize your pain, we numb the skin and deeper tissues with local anesthetic before inserting a needle in the INB’s.

Will I be “put out” for the intercostal nerve block?

This procedure is commonly done with a small thin needle, usually without any sedation. Prior to the injection, you will be numbed with local anesthetic.

How is the intercostal nerve block performed?

It is usually done with the patient lying down on the opposite side of the painful region, so the painful region will be facing up. The skin of the chest is cleaned with antiseptic solution and then the injection is performed.

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 any unforeseen complications, you may return to to work if you feel up for it. The most common side effect of intercostal nerve blocks is soreness at the injection site.

How long does the effect of the medication last?

The local anesthetic gives you immediate effect and the steroid begins working between 2-7 days after the injection, but can last several days to months.

How many intercostal nerve blocks do I need to have?

The number of INB’s necessary to achieve pain relief can vary. The injections are typically scheduled about a week apart. 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?

If the symptoms are easily identified to one nerve, that nerve will be targeted and blocked. There are also certain times where several nerves need to be targeted,sometimes up to three nerves. If this is the case, the nerve responsible for the most of the symptoms is blocked and then one nerve is blocked at the level above and one at the level below.

Will the intercostal nerve blocks help me?

Although it is difficult to predict with 100% accuracy, we do know that patients who have recent (acute) onset of pain may respond much better than the ones with long standing (chronic) pain.

Often, the first injections are used to help diagnose the problem and make a more accurate diagnosis by confirming that are involved in the pain. On the other hand, if the blocks don’t help the pain, those specific nerves will not be suspected as part of the pain as a target for further treatment

What are the risks and side effects of intercostal nerve blocks?

Although there are always risks, side effects and possibility of complications, INB’s are generally safe procedures. The most common side effect is soreness at the injection site, but more uncommon side effects include infection, bruising, bleeding, and worsening of symptoms Fortunately, serious side effects and complications are uncommon. The most serious side effect of INB’s is a punctured lung, which is very rare, but if it were to occur, it would require close observation.

How would I know if I had a collapsed lung?

Because of the small sized needles used in INB’s, it is very rare for a lung to collapse quickly. Rather, lung collapse may take over several hours. It is important to monitor whether the patient feels short of breath or gasps for air, which would suggest a punctured lung. . Prompt transportation to the nearest Emergency Room and a chest x-ray can help diagnose a collapsed lung.

Who should not have an intercostal nerve block?

Patients who have an allergy to any of the medications that are injected, are on blood thinners as a part of their medication regimen, have an active infection or have poorly controlled diagnoses such as diabetes or heart disease may not be good candidates for an intercostal nerve block and may have to be postponed until their medical condition improves.

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