• Intercostal Nerve Block

    1. What is an intercostal nerve block?

    An intercostal nerve block is an injection of local anesthetic, with or without steroids, just under the rib where the intercostal nerve lies. An intercostal nerve block is typically ordered by your doctor for pain in the your rib area that develops following surgery in that area, a rib fracture, herpes zoster (shingles) or an intercostal nerve entrapment or inflammatory condition.

    An intercostal nerve block may have diagnostic or therapeutic value. One of three things will happen:

    1. The pain does not go away, which means that the pain is probably not coming from the nerve(s) at the level(s) of the injection. This result has diagnostic value.
    2. The pain goes away and stays away for a few hours but comes back and does not get better again. This is also of diagnostic value, as the pain is probably coming from the nerve(s) at the level of the injection(s), but the steroid, if used, was not of benefit.
    3. The pain goes away after the block and may come back later that day, but then it improves again over the next few days. This means that the block was of therapeutic value-the steroid had a long-lasting effect on the pain.

    If you get good, lasting benefit from the injection, the block may be repeated. We also may be able to perform radiofrequency destruction of the nerves, which can last for a prolonged period of time (months to years).

    Please note: This procedure cannot be performed if you have an active infection (and are on antibiotics), flu, fever, extremely high blood pressure, or if you are on blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal). Blood thinners must be stopped five to seven days prior to the procedure. For your safety, please inform us if any of these conditions exists.

    2. What are the risks of the procedure?

    As the rib cage is designed to protect the lungs, there is a risk, although extremely small, of collapsing the lung if the needle penetrates the lung. This is called a pneumothorax. If severe, this could require the placement of a chest tube to re-inflate the lung. As with most procedures, there is a remote risk of bleeding, infection, nerve injury or allergic reaction to the medication used.

    3. What happens during the procedure?

    After you check in and sign a consent form, your vital signs will be taken. Then you will be taken to the procedure room. Please wear loose-fitting clothing. You may be asked to change into a hospital gown. You will have an IV catheter placed. Our nursing staff will position you on your stomach on a narrow table. Your back will be cleaned with iodine and sterilely draped. Then, the doctor will numb your skin with a small needle, which will sting just a bit. It is very important to hold still and let us know if we are causing you discomfort. Next, the doctor will use an X-ray machine (fluoroscope) to guide the needle into the correct spot. Local anesthetic-with or without steroid-is then injected, and the needle is removed. This is repeated for as many levels as needed. Your skin will be cleaned and a Band-Aid(s) applied. (The Band-Aid(s) may be removed the next morning.)

    Your pain may improve immediately after the injection, due to the local anesthetic. It is important to keep track of how you feel for the remainder of the day. The steroid usually takes two or three days to have an effect in most people, and peaks in about two weeks. It is important that you keep track of the amount of pain relief you receive, as well as how long the pain relief lasts.

    4. What happens after the procedure?

    You will be taken to the recovery area, where you will remain for 5 to 15 minutes. After your vital signs are taken, you may be discharged. If you experience local tenderness from the needles, ice may help relieve the discomfort. You can also resume taking your normal pain medications.

    5. Will I have any restrictions after the procedure?

    Following your procedure, you are not allowed to drive for the remainder of the day. An adult must be present to drive you home or to escort you on another form of transportation. This is for your own safety. In addition, do not go swimming or soak in a tub or Jacuzzi on the day of your procedure. Otherwise, you may do whatever you feel up to doing.

    6. For what reasons should I call the Pain Management Center after the injection?

    You should call us immediately at 781-744-5090 if you experience any of the following:

    • Severe back pain that is not relieved with medication and ice
    • Prolonged, new numbness or weakness of your legs
    • Loss of control of your bladder or bowels
    • Signs of infection in the area of injection

    If you have any difficulty breathing, please go to the nearest emergency room immediately, as there is a possibility that you may have a pneumothorax.

    Things to Do Before the Procedure

    • Any dietary restrictions will be discussed on the day the procedure is booked.
    • Take all of your medications as scheduled on the day of the procedure, unless directed otherwise.
    • Think of any questions for us and write them down.
    • Make the nurses and doctors aware of any new changes in your medical condition.
    • Before you come in, let us know if you are taking any blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal) or anti-inflammatories.
    • Please remember to arrange for an adult to drive you home.
  • Make an Appointment

    (781) 744-5090