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Intercostal Nerve Block

The intercostal nerves run along each rib from the spine in the back to the sternum in the chest. These nerves can become irritated, inflamed or damaged, which can result in a band-like pain along the chest wall.

An intercostal nerve block can relieve this pain and increase circulation in the area. During this procedure, local anesthetic is injected near the nerves that supply the area in pain.

If your pain is relieved by this procedure, a series of blocks may be used as an attempt to break the pain cycle.

Patient guidelines (PDF) ›

Procedure overview (PDF) ›

What is the goal of an intercostal block?

The goal is to provide pain relief so that you are able to resume normal activities. The steroid helps to decrease inflammation in the specific location where it is most needed. The steroid may help the injury heal by reducing inflammation. It may provide permanent relief or a period of a few weeks/months of relief while the injury is healing.

What happens before a treatment?

You will be escorted to a room where a nurse will conduct a pre-procedure interview. The physician who will perform the injection will review your medical history, previous imaging studies, physical exam and current medications to help plan the best approach for the injection.

What happens during the procedure?

You will remain awake during the entire process, and your blood pressure, heart rate and breathing are continually monitored.

While you are lying face down on the procedure table, the injection site is cleansed with an antiseptic. A needle is then inserted through the skin, muscle and soft tissues, so there is some slight discomfort involved.

An injection of local anesthetic (numbing medication) will be administered in the area where you are experiencing pain. The physician then directs a needle with the use of X-ray guidance and deposits the medication. This procedure takes approximately 30 minutes.

Should I limit my activity or change my diet after the injection?

No. Unless your doctor tells you otherwise, you may return to your usual activities.

Are there any side effects caused by an intercostal nerve block?

  • The most common side effect is pain at the site of injection.
  • A pneumothorax (collapsed lung) is extremely rare, but it is a serious condition. If you experience shortness of breath or sudden, severe and sharp chest pain, seek medical attention immediately.

For diabetic patients

If you have diabetes, it is important to know the steroid (anti-inflammatory) can cause an elevation in your blood sugar level for up to two weeks after the injection. You should check your blood sugar more often than usual for several days after an epidural steroid injection. If your blood sugar is elevated, please contact the doctor who manages your diabetes for instructions on how to change your diet and/or adjust your diabetes medication.

Are there any restrictions after an intercostal nerve block?

Yes. You should follow these restrictions after the procedure:
  • Do not drive for the remainder of the day.
  • Do not take a tub bath or soak in water (pool, hot tub) for 24 hours after the injection.
  • Wait three days after the procedure before resuming physical therapy.

What are the medications used for an intercostal nerve block?

  • Lidocaine or bupivacaine are local anesthetics that are used to numb the area of injection; this numbness usually wears off within two to six hours.
  • Triamcinolone (Kenalog®) is a steroid used to treat inflammation and pain. The effects of this steroid may take up to 10 days to appear.
  • Lopamidol, an X-ray contrast agent, may be injected into the area to confirm correct placement.

When should I call my doctor?

You should call your doctor immediately if any of the following occurs:
  • Swelling, redness, bleeding or discharge from the site of the injection
  • A fever greater than 100˚F
  • New or worsening back or neck pain
  • New numbness or weakness in your arms or legs
  • Chest pain or shortness of breath, difficulty breathing, shoulder pain or pain with coughing or deep breathing
To be seen by one of our specialists, call 949-UCI-PAIN (949-824-7246) or request an appointment online ›
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