Intercostal Nerve Ablation or Neurotomy
As stated above, the area in between the shoulders and around the sides to the front side of the chest is innervated by the intercostals (or rib) nerves. Generally, these nerves start in the back and provide sensation around to the front of the chest, converging at the sternum (or breast bone) and the front of the abdomen. These nerves can become painful after outbreaks of shingle or herpes zoster, as well as chest surgery (to include cardiac and lung surgeries). These nerves can be disrupted to provide pain relief for extended periods of time, if a successful or positive block is observed.
During the procedure, the patient lies face down on the procedure table in a clean operating room. The patient’s vitals signs are collected and checked for appropriateness. The patient upper back area is cleaned with an antiseptic and draped using sterile technique. Using fluoroscopic (low dose x-ray) guidance, the ribs (nerves travel under the ribs) which correspond to the painful areas are identified and the skin is anesthetized. Using a small needle, the bottom part of the rib is contacted and the needle is slipped under the rib. The location of the nerve is further identified by sensory testing using a special machine. Local anesthetic is injected into the area to numb the nerve before radiofrequency thermal energy is applied to disrupt the nerve. A solution of anesthetic and steroid is injected after the procedure to decrease inflammation in the area. The disruption of this nerve is not permanent as the nerve grows back, but it can provide pain relief up to six to nine months.