Intercostal Nerve Block

It is an injection of long lasting steroid medication into the nerve that lies under the rib in the intercostal space – that is the area between the ribs.

What is the purpose of it?

The steroid injected reduces the inflammation and/or swelling of tissue around the intercostal nerves, between the ribs or in the chest wall. This may in turn reduce pain, tingling/numbness and other symptoms caused by nerve inflammation/irritation or swelling.

How long does the injection take?

The actual injection only takes a few minutes, but plan to be in the office for one to two hours.  This allows for your pre-op and recovery time as well.  Your driver must remain in the building during your procedure.

What is actually injected?

The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication (triamcinolone or methylprednisolone).

Will the intercostal nerve block hurt?

The procedure involves inserting a needle through the skin and deeper tissue (like a tetanus shot). So, there is some discomfort involved.  However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle just prior to the performance of the block. Most patients opt to receive IV sedation, which makes the procedure easier to tolerate.

Will I be “Put Out” for this procedure?

No. This procedure is done under local anesthesia.  If you do not feel comfortable with just the numbing medication, we give you the option of intravenous sedation.  The amount of sedation given generally depends upon the patient’s tolerance.

How is the injection performed?                                                                                                                   

The procedure is done with the patient lying on their stomach under live x-ray. The patient is monitored with an EKG, blood pressure cuff and blood oxygen- monitoring device. The back is cleaned with antiseptic solution and then the injection is carried out.

What should I expect after the injection?

Immediately after the block, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. You may feel sore for two to three days and/or may have increased pain. This is due to the mechanical process of the needle insertion as well as the initial irritation from the steroid itself. You should start to notice pain relief within three to seven days.

What should I do after the procedure?

You should have a ride home after the procedure. We advise patients to take it easy the day of the procedure. You may apply ice to the affected area and perform activities as tolerated.

Can I go back to work the next day?

Yes, you should be able to return to work unless the procedure was complicated.

How long does the effect of the medication last?

The steroid starts to work in about five to seven days and can last for several days to a few months.  The extent and duration of the pain relief may depend on the amount of nerve inflammation.

How many injections do I have to have?

If the first injection does not relieve your symptoms in about a week or two, you may be advised to come in for an office visit to discuss further options or to have another injection. Generally we do not repeat injections that do not help your symptoms. You can only have three to six injections a year.

Will the injections help me?

It is very difficult to predict if the injection will indeed help of not. Generally speaking, the patients with a recent onset of pain may respond better than the ones with a long standing history of pain.

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain- which is temporary. The other risks involve infection, bleeding, worsening of symptoms, collapsed lung, etc. Other risks related to the side effects of the steroid include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body’s own natural production of steroid, etc.

How would I know if I had a collapsed lung?

Due to the small size of the needle used, a lung usually does not collapse quickly; it may take several hours or the better part of a day.  If, after the block, you feel winded or cannot seem to catch your breath or gasp for air, a collapsed lung should be suspected.  Go to the nearest Emergency Room should these symptoms develop, a chest x-ray can confirm if your lung has collapsed.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (ex: Coumadin, Plavix, Aspirin), if you have an infection going on, or if you are pregnant or suspect you may be pregnant, you should not have the injection.

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