Learning About Intercostal Nerve Block

An intercostal nerve block is an injection (shot) of medicine close to the intercostal nerves to numb the nerves and treat pain in your chest and upper belly. The intercostal nerves start at your spine and run underneath your ribs.

Usually an intercostal nerve block injection contains both an anesthetic (numbing medicine) and a steroid (medicine to lower inflammation).

An intercostal nerve block can help with pain in your chest area. For example, it's used for pain after a shingles infection (postherpetic neuralgia), broken ribs, or surgery. Doctors may also use it if they’re not sure where your pain is coming from. They can block the nerve that they suspect is causing your pain to see if it goes away. This can help narrow down the best treatment option for you.

Before the procedure:

• Tell your doctor about any medicines or supplements you take. This is especially important if you take blood thinners, since those could cause problems during the nerve block.
• Let your doctor know if you might be pregnant.
• Follow any directions your doctor may give you for not eating or drinking before getting the nerve block.

You might get a sedative (a medicine to help you relax) through a needle into your arm. You’ll lie down on an exam table on your side or on your belly. Your doctor or nurse will clean your skin with an antiseptic where the needle will be placed.

Then your doctor will inject a medicine to numb the skin in the area where you’ll get the nerve block. To find the right spot to place the nerve block, your doctor might use imaging, like ultrasound or fluoroscopy (a type of X-ray), to help guide them. When your skin is numb, they’ll inject the medicine for the nerve block as close to the affected nerve as possible.

Most people are able to go home the same day. If you had sedation to help you relax, you’ll need someone to drive you home from the hospital.

You’ll rest at home for a day or two. Your doctor can tell you when it’s safe to resume your normal activities.

The effects from the nerve block can last a few hours, days, weeks, or even months. It all depends on the type of medicine you got, the dose, and how well your body responds to the medicine. If the medicine you got contained steroids, it may take 3 to 5 days for your pain to get better.

If the nerve block works to relieve your pain, you may be able to repeat the procedure regularly to control your pain in the long term. There is also a chance that the nerve block won’t work to relieve pain. If that happens, you’ll work with your doctor to try other things.

Like every operation, an intercostal nerve block has possible side effects and risks. The most common side effect is bruising or pain where you got the injection. This usually goes away within a few days.

Serious side effects are rare, but they can happen. These include:

• Infection or bleeding.
• Nerve damage.
• A collapsed lung.
• An allergic reaction to a medicine.
• Local Anesthetic Systemic Toxicity (LAST), a rare problem that can happen if the medicine is absorbed into the bloodstream too quickly.