What is an Intercostal Nerve Block?

Intercostal nerve blocks explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Intercostal Nerve BlockMany emergency room visits in the United States concern abdomen or chest pains. Both external illnesses, such as herpes zoster (shingles), and internal injuries can cause significant pain that can be exacerbated very quickly. Pain in these areas can be difficult to diagnose and treat, due to the number of important structures and organs contained therein.

One of these is the ribs, a structure made up of a cage of bones and muscles known as intercostal muscles. Chest or abdominal pain can be related to pain in these areas. An intercostal nerve block is a largely non-invasive procedure in which a pain blocking injection is delivered to the intercostal nerves that are responsible for the intercostal muscles. This reduces painful signals sent from the chest and abdomen to the brain. This may effectively treat pain in these regions.

Intercostal nerve blocks are popular with physicians treating chronic pain and inflammation in the abdomen or chest for a prolonged period of time. Patients with pain that is resistant to opioid treatments, or who wish to avoid using them, often find intercostal nerve blocks are a viable and less risky pain management option. Surgeons may also use intercostal nerve blocks as part of analgesia during major thoracic or abdominal procedures.

How is an Intercostal Nerve Block Performed?

Intercostal Nerve Block FluoroscopyA diagnostic intercostal nerve block is performed to eliminate possible causes of chronic pain. A nerve block can confirm if the nerve(s) in question are responsible for consistent pain signaling. If the patient does not have a significant analgesic response to a diagnostic block, then the nerve is not implicated in the pain condition. On the other hand, if the patient experiences pain relief as a result, then the pain is diagnosed as being associated with the nerve treated. Intercostal nerve blocks, as applied in pain relief therapy, can achieve significant short-term inhibition of pain in the chest or abdomen.

An intercostal nerve block is an out-patient procedure and typically only requires minutes to perform. The nerve block is an injection the patient receives while sitting or lying on their side opposite to the area to be treated. The physician sterilizes the area of skin over the nerve with antiseptic solution. A hypodermic needle is loaded with a local anesthetic and inserted into the vicinity of the intercostal nerve(s) in question. The anesthetic inhibits or blocks the nerve from sending painful signals for a short period of time.

The patient is advised to ice the injection site when they return home, and to rest and avoid strenuous activity for the 24 hours following an intercostal nerve block procedure. Intercostal nerve blocks are a safe and effective pain treatment, but there is a low incidence of complications associated with the procedure. These may include infection, tenderness, and discomfort in the injection site, local anesthesia toxicity, skin discoloration, bruising, bleeding, hematoma, and allergic reaction. Intercostal nerve blocks may take up to a week to show noticeable pain-relieving effects.

Conditions Related To Intercostal Nerve Block Treatment

Herpes ZosterIntercostal nerve block is associated with significant effects in cases of bone cancer, internal injury, external injury, or other ailments of the chest area. Intercostal nerve block treatment is also popular as analgesia in the course of invasive surgeries, such as thoracotomies, which make the experience easier to bear for the patient. Patients who are contraindicated for surgery due to other health conditions may find intercostal nerve blocks helpful as an alternative method of pain management. Research indicates that intercostal nerve blocks are equally effective and in some cases longer-lasting in comparison with opioid medications.

Conclusion

A range of conditions and injuries are associated with chronic pain in the chest and abdominal areas. The intercostal nerves control the musculature of the ribs and are also associated with sending pain signals from these regions to the brain. An intercostal nerve block, in which these nerves are injected with local anesthetics, is effective in providing significant relief from chronic thoracic or abdominal pain. They are popular with pain physicians and with thoracic surgeons who use them as part of analgesic strategies for major procedures. An intercostal nerve block will not achieve pain relief in the long term, but it is effective over several months, after which another injection can be performed.

At Pain Doctor our goal is to relieve your pain and improve function to increase your quality of life.
Give us a call today at 480-563-6400.

References

  1. Bulger EM, ArnesonMA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48(6):1040–1046.
  2. Debreceni G, Molnar Z, Szelig L, Molnar TF. Continuous epidural or intercostal analgesia following thoracotomy: a prospective randomized double-blind clinical trial. Acta Anaesthesiol Scand. 2003; 47: 1091–5.
  3. Joshi GP, Bonnet F, Shah R, et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg. 2008;107(3):1026–1040.
  4. Lennard T.A.: Pain Procedures in Clinical Practice. Philadelphia, Hanley & Belfus, 2000.
  5. Moore K.L., Agur A.M.R.: Essential Clinical Anatomy. Philadelphia, Lippincott Williams & Wilkins, 2006.
  6. R Jain, S Mishra, G Goyal, H Chauhan, S Bhatnagar. Management of Central Nervous System toxicity after Intercostal nerve block with bupivacaine. The Internet Journal of Anesthesiology. 2007 Volume 17 Number 2.
  7. Schimmer BP, Parker KL. Adrenocortical steroids. In: Hardman JG, Gilman AG, Limbird LE. Goodman and Gilman’s The pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill; 1996:1465-81.