The intercostal nerves are located underneath the lower edge of each rib, and they provide sensation to the chest area. An intercostal nerve block is a diagnostic and therapeutic injection therapy that provides pain relief to patients who’ve sustained nerve injuries to the chest wall. These nerve blocks assist in identifying the origin of chest pain as well as treating acute or chronic herpes zoster, shingles, or post-operative chest scar pain. While it is impossible to predict how long a patient will experience pain relief from an intercostal nerve injection, many patients report prolonged relief lasting weeks, months, or years. On the other hand, some patients encounter transient relief that only lasts a few hours to several days. A series of 3-5 intercostal nerve block injections may be necessary for patients who experience short-term pain relief.
An intercostal nerve block is performed with the patient lying on his or her stomach with the arms positioned upward. The patient's blood pressure and oxygenation are monitored throughout the procedure to reduce the risk of complication. Intravenous sedation or a local anesthetic may be administered before the injection to help minimize patient discomfort. To begin, the skin over the affected rib(s) is cleaned with antiseptic solution, and a small needle is carefully placed under the rib. A contrast dye is injected first to help the physicians identify the nerve's pathway. Following this injection, the medication is introduced into the nerves to provide partial or complete pain relief. Patients may experience numbness around the rib cage and minor soreness or bruising at the injection site. After the injection, the needle is removed and the patient is sent to another room to recover.
This procedure is very safe, but rarely, serious health problems can occur. Patients who experience sharp stabbing chest pain, rapid or difficult breathing, or a rapid heartbeat should report their symptoms to an Orthopedic and Wellness physician immediately. Patients will need to monitor their pain relief levels over the next several weeks following an injection. A follow-up visit will need to be scheduled one week after the intercostal nerve block to review the results with an Orthopedic and Wellness nurse. Patients who experience 100% relief that lasts at least a week will likely defer further injections until pain symptoms reappear. If partial or transient relief is achieved, patients may need a series of blocks at regular intervals for sustained pain relief. If the patient develops a problem that he or she is concerned about, they should call the office to schedule an appointment. Or, if the concern is life-threatening, patients should visit the nearest emergency room.