Maybe it starts off as a tight feeling between your ribs that is mildly painful when you breathe. Perhaps the feeling starts in the abdomen, near the back of your body. Whether it’s acute and sharp or chronic and dull, pain in the chest and diaphragm can be a real concern. An intercostal nerve block is a pain-relieving tool that can also help diagnose the cause of your pain. Here’s what you should know.
What is an intercostal nerve block?
Intercostal nerve blocks treat pain in the chest and upper abdomen areas through the use of a steroid injection. They specifically target the intercostal nerves.
Intercostal nerves are laced between the ribs in the middle portion of the spine (the thoracic spine). One branch of your intercostal nerve travels along the ribs and threads through the intercostal muscles—the small muscles between your ribs. Ending at the pectoral muscles, these nerves bring sensation to the front of the chest.
Other branches of the intercostal nerves supply the abdominal wall and the thoracic wall (the area in front of your spine inside the body). These nerves enter the muscles of the abdominal wall, passing in between the abdominal muscles before branching out to the skin.
The intercostal nerves enervate your whole diaphragm, even the membrane that lines the abdomen. Muscles, skin, and bones in the upper chest and abdomen, plus the area between the lungs, receive sensations from these nerves.
An intercostal nerve block can be effective in relieving chronic pain without the side effects of pain medications. The intercostal nerve is easy for your doctor to access, and the procedure is low risk. Even better, a single block can result in permanent pain relief.
Intercostal nerve block benefits
Patients suffering from chronic pain that is unresponsive to conservative treatments may find an intercostal nerve block reduces their pain or relieves it completely. Conditions treated with the intercostal nerve block include:
- Neuropathic pain in the chest associated with herpes zoster (shingles)
- Postoperative pain from chest or upper abdominal surgery
- Chronic pain after mastectomy
- Rib fracture pain
- Pain related to scar tissue formed after surgery
- Pain related to metastatic cancer in the ribs
There are a variety of potential intercostal nerve block benefits. To start, the procedure is short and conducted on an outpatient basis, with very little recovery time.
A nerve block is also a good alternative to opioid pain medications, which carry many dangerous side effects. If the initial block is successful, the patient is a candidate for repeat injections to treat recurring pain.
Intercostal nerve blocks are not only used for pain relief but also as a diagnostic tool. Intercostal nerves do not communicate with internal organs themselves. In this way, a diagnostic block that does not relieve pain may point to conditions that are not related to the intercostal nerve.
How does the intercostal nerve block procedure work?
An intercostal nerve block procedure may be performed along with chest and abdominal surgery, or it may be an outpatient procedure done on its own. The entire procedure, from the injection to a brief monitoring period, takes under an hour.
Once you check in with your doctor and have all of your questions answered, you will rest in a position that allows your doctor clear access to the injection site. An intercostal nerve block can be performed in a variety of positions. Which one your doctor chooses depends on injection placement.
Unless you are having another surgery, you will be awake for the procedure. Most patients find the injections to be mildly comfortable but not painful. If you are concerned about pain, talk to your doctor about your options.
Once you are in position and completely still, the injection site is cleaned and injected with anesthetic. Your doctor uses fluoroscope (X-ray) guidance to correctly place the needle. Once correct placement is verified, the intercostal nerve block injection is administered. You may have a nerve block at just one site or your doctor may place multiple blocks along the nerve.
You can watch Dr. Lynch perform the procedure in the following video.
Intercostal nerve block risks
An intercostal nerve block involves inserting a needle between the ribs. As with any procedure, the risk of complications exists. These include:
- Pneumothorax, or collapsed lung caused by penetration of the needle
- Nerve damage
- Local anesthetic toxicity
- Spinal anesthesia (very rare)
- Allergic reaction to medications given
Using fluoroscopic guidance to place the needle reduces the risk of complications, as does working with a doctor who has experience in this procedure.
Intercostal nerve block recovery
The intercostal nerve block recovery period is short and usually easy.
On the day of your procedure, avoiding driving or vigorous activity. If you experience pain or bruising at the injection site, apply ice for 20 minutes at a time. Non-steroidal anti-inflammatory drugs (NSAIDs) can relieve any soreness. The majority of patients return to their normal activities the following day. If you experience signs of infection (e.g., swelling, fever, pain at the injection site), call your doctor immediately.
A successful procedure is marked by almost immediate pain relief. The anesthetic provides immediate pain relief that lasts a few hours. It takes longer for the steroid component to reduce inflammation and relieve pain. The steroid takes effect in about three to five days and can continue to provide pain relief for weeks or months.
Even after a successful block, pain relief varies. For example, acute pain sufferers respond better to a nerve block than chronic pain sufferers. Patients who respond positively to treatment may receive repeat injections over time to prolong pain relief. Once it’s clear that the intercostal nerve is the source of the pain, a permanent ablation can be performed to provide long-term pain relief.
If you still have pain, this indicates either an unsuccessful block administration or that the source of pain is not related to the intercostal nerve.
Whether your pain is from acute injury or chronic condition, you don’t need to suffer. Arizona Pain’s compassionate doctors can help you find relief with a treatment plan that includes intercostal nerve blocks.