Intercostal nerve block explained

Intercostal nerve block (abbreviated ICNB) is a nerve block which temporarily or permanently interrupts the flow of signals along an intercostal nerve, usually performed to relieve pain.^[1]

Uses

An ICNB relieves the pain associated with injured intercostal nerves. This pain can arise from chest surgery, physical trauma, aggravation of the shingles virus, or pressure put upon the nerves during pregnancy.

Techniques

Anesthetic nerve block

Injecting local pain relievers and steroids into the injured area alleviates intercostal nerve pain. In this type of nerve block, a needle inserted between two ribs releases a steroid into the area around the nerve. The exact location of injection depends on the underlying cause of the injury. After three to five days, the steroid begins to relieve pain. Depending on the individual, the pain-relieving effects of the steroid last for days to several months.

Risks

Injection without a device such as an ultrasound or fluoroscope to guide the needle can cause pneumothorax, a condition where air enters the cavity surrounding the lung or into a blood vessel causing local anesthetic toxicity.^[2] Other newer facial plane blocks may be an alternative option due to a preferential safety profile ^[3]

Neurolysis

Physicians can also treat intercostal nerve pain by intentionally damaging the intercostal nerves. This process, known as neurolysis, prevents the nerves from sending pain signals. In chemical neurolysis, a needle injects alcohol or phenol into the nerve and prevents the conduction of pain signals. Neurolysis can also be accomplished through a process known as radio-frequency lesioning. In radio-frequency lesioning, a needle transmits radio waves to the nerve and interrupts regular pain signaling.^[4]

Additional images

Further reading

• Richard S. Weinered. (2001). Pain Management: A Practical Guide for Clinicians, Sixth Edition CRC Press. p. 461
• Book: Lennard, TA . Vivian, DG . Walkowski, SD . Singla, AK . Pain procedures in clinical practice. Elsevier/Saunders. 2011. Philadelphia. 289–92. 978-1437737745. 3rd .
• Book: Erdine, P. Prithvi Raj, Serdar. Pain-relieving procedures : the illustrated guide. 13 August 2012. Wiley-Blackwell. Chichester, West Sussex. 14–27. 978-0470670385.
• Book: Franco, KL. Putnam JB. Advanced therapy in thoracic surgery. 1998. B.C. Decker. Hamilton, Ont.. 4–8. 1550090445.
• Web site: Poon. Alan. Intercostal nerve block. American Society of Regional and Pain Medicine. 1 January 2014. https://web.archive.org/web/20141103021551/http://www.asra.com/pain-resource-center-regional-anesthesia-intercostal-nerve-block.php. 3 November 2014. dead.
• Book: Bridenbaugh, PO. Cousins, MJ . Neural blockade in clinical anesthesia and management of pain. 1998. Lippincott-Raven. Philadelphia. 457–63. 0397511590. 3rd.
• Book: Moore, Keith L. Moore, Anne M.R. Agur; in collaboration with and with content provided by Arthur F. Dalley II; with the expertise of medical illustrator Valerie Oxorn and the developmental assistance of Marion E.. Essential clinical anatomy. 2007. Lippincott Williams & Wilkins. Baltimore, MD. 48–65. 978-0781762748. 3rd .
• Book: Benzon, HT . Rathmell, JP . Wu, CL . Turk, DC . Argoff CE . Raj's practical management of pain. 2008. Mosby-Elsevier. Philadelphia. 749–52. 978-0323070799. 4th .
• Ho. AM. Karmakar, MK . Critchley, LA . Acute pain management of patients with multiple fractured ribs: a focus on regional techniques. Current Opinion in Critical Care. Aug 2011. 17. 4. 323–7. 21716105. 10.1097/mcc.0b013e328348bf6f. 5206646.
• Karmakar. MK. Ho, AM. Acute pain management of patients with multiple fractured ribs.. The Journal of Trauma. Mar 2003. 54. 3. 615–25. 12634549. 10.1097/01.ta.0000053197.40145.62.
• Book: Waldman, Steven D.. Atlas of interventional pain management. 2009. Saunders/Elsevier. Philadelphia, PA. 978-1416099949. 3rd. 295–7.
• Moore DC, Bridenbaugh LD . Intercostal nerve block in 4333 patients: indications, technique, and complications . Anesth. Analg. . 41 . 1–11 . 1962 . 14475639 . 10.1213/00000539-196201000-00001. free .
• Tucker GT, Moore DC, Bridenbaugh PO, Bridenbaugh LD, Thompson GE . Systemic absorption of mepivacaine in commonly used regional block procedures . Anesthesiology . 37 . 3 . 277–87 . September 1972 . 5051605 . 10.1097/00000542-197209000-00003. 38627773 . free .
• Book: Hidalgo, NRA. Complications of regional anesthesia. 2007. Springer. New York, N.Y.. 978-0387689043. 111–4. 2nd. Ferrante FM. Finucane, BT.
• Maddox TG . Adverse reactions to contrast material: recognition, prevention, and treatment . Am Fam Physician . 66 . 7 . 1229–34 . October 2002 . 12387435 . Review.

External links

• An intercostal nerve block page on the Johns Hopkins School of Medicine website

Notes and References

1. Book: Rathmell . James P. . Atlas of Image-Guided Intervention in Regional Anesthesia and Pain Medicine . 2012 . Lippincott Williams & Wilkins . 9781451154429 . 196 . 15 September 2018 . en.
2. Web site: Pneumothorax - Symptoms and causes. 2020-09-18. Mayo Clinic. en.
3. White . L. D. . Riley . B. . Davis . K. . Thang . C. . Mitchell . A. . Abi-fares . C. . Basson . W. . Anstey . C. . Safety of Continuous Erector Spinae Catheters in Chest Trauma: A Retrospective Cohort Study . Anesthesia & Analgesia . 2021 . 133 . 5 . 1296–1302 . 10.1213/ANE.0000000000005730 . 34473654 . 0003-2999. 10072/407871 . 234492181 . free .
4. Web site: Radiofrequency neurotomy - Mayo Clinic. 2020-09-18. www.mayoclinic.org.