The intercostal nerves control the contractions of the muscles surrounding each rib and provide the brain with sensory information. Inflammation or irritation in this area can cause pain. Intercostal nerve blocks are injections into the intercostal nerves to relieve pain. Doctors use these as a pain management tool or as a diagnostic tool to diagnose the source of your rib or chest pain. This minimally invasive outpatient procedure increases circulation to the intercostal nerves and decreases inflammation.
Intercostal nerve blocks are a pain management tool for conditions, such as:
Herpes zoster infection or shingles
Provides pain relief
Can help diagnose chest pain
Short recovery period
Before your procedure, your doctor may ask you to stop taking non-steroidal anti-inflammatory drugs (NSAIDs), immunosuppressant medication, and blood thinners to reduce your risk of serious complications or infections. If you are pregnant or suspect you are pregnant, talk to your doctor about alternative treatment options. Your healthcare professional may ask you not to eat or drink several hours before the procedure. This procedure cannot be performed if the patient has an active infection or symptoms of a cold, flu, or similar malady. If you experience these symptoms on the day of the procedure, you will need to reschedule your nerve block.
During the procedure, the healthcare professional performing the procedure will have you lie on the examination table on the side opposite your chest pain. They will administer anesthesia through an IV to help you relax. The physician will then sanitize the area of skin near the ribs before injecting a local anesthetic into that area. Using x-ray guidance and contrast dye, they will then inject medicine into the body. If the intercostal nerve block is for therapeutic purposes, they will inject a corticosteroid. If it is for diagnostic purposes, they will inject a local anesthetic or numbing agent.
The procedure lasts less than thirty minutes. Afterward, you will remain in an observation room until the general anesthesia wears off to ensure no immediate complications or reactions occur.
Once discharged, you will be unable to drive or perform any rigorous activity for the remainder of the day. You will need someone else to drive you home from your procedure. You cannot take a bath or soak in water for 24 hours after the injection. Your healthcare professional will recommend relaxing for the remainder of the day before returning to your normal activities.
You may experience an increase in chest or rib pain at the injection site, but this pain should dissipate within 48-72 hours. If the pain becomes intolerable, you can take over-the-counter pain medicine or apply an ice compress.
The onset of pain relief and its duration varies greatly among patients. Some patients report feeling immediate pain relief, while others feel relief after several days. Intercostal nerve blocks used for diagnostic reasons should provide pain relief within the same day, while therapeutic intercostal nerve blocks may take up to ten days to provide pain relief. Your pain relief may last several weeks or several months. If these nerve blocks successfully relieve your chest or rib pain, your healthcare professional may suggest adding periodic nerve blocks to your routine treatment regimen.
While intercostal nerve blocks are generally safe procedures, there remains a chance for complications to arise. Risks for this procedure include:
Infection, bleeding, bruising, and soreness at the injection site
Allergic reaction to steroids or anesthesia
Elevated blood sugar for those living with diabetes