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