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Intercostal Nerve Block

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, 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 blocked or disrupted to provide pain relief for extended periods of time.

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 rib bone) 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. A solution of anesthetic and steroid, dependent on technique, is injected. It takes up to 20 minutes for the medication to take effect. The patient is asked to keep a pain journal for the next few days; the first five hours are the most important. The patient is reassessed in the following week to determine the efficacy of the procedure. If the procedure has provided pain relief, then the patient may be scheduled for the second part of the procedure that involves thermal disruption of these intercostal nerves. The disruption of this nerve, which is described later under Advanced Procedures, can provide pain relief up to six to nine months.