Intercostal Nerve Blocks
What are intercostal nerves and why are they blocked?
The intercostal nerves are located below each rib. If hurt or damaged, they can cause pain which travels around the chest. They can be injected to see if they are the source of pain and if relief can be obtained.
A mixture of numbing medicine and steroid is injected under the rib where the nerve is. This will numb the area and will tell the doctor if the rib or nerve is the cause of the pain. The steroid will act over time to decrease pain.
What happens during the procedure?
You will need to arrive 30 minutes before your injection. You will be asked to lie face down on an X-ray table so the doctor can see your ribs using an X-ray machine. The skin on your back is cleaned. Next, the doctor numbs a small area of the skin.
This stings for a few seconds. The doctor then puts a very small needle, using x-ray guidance, under the rib. The medicine is then injected. One or more ribs may be injected depending on your usual pain.
What happens after the procedure?
You will need to stay a short time after the injection, about 30 minutes. Your vital signs will be checked and you will be watched for changes in pain, any weakness, or problems such as shortness of breath. This is fairly uncommon but sometimes happens. A dressing may be applied to the injected area. You will be asked to describe any change in your pain. The nurse will review your discharge instructions with you and you will be able to go home. You may experience increased pain following the injection. You will also be instructed by the nurse to watch for changes in your breathing pattern after the procedure.
You must have someone drive you home.
- Watch for shortness of breath and changes in your pain.
- No driving allowed for 6 hours following the procedure.
- Resume normal activity the following day. Your doctor will tell you when you may return to work.
- Resume regular medications including blood thinners.
General Pre/Post Instructions
You may eat a light, but not full meal at least one hour before the procedure, unless receiving intravenous sedation. If you are an insulin dependent diabetic do not alter your normal food intake.
Take your routine medications before the procedure (such as high blood pressure and diabetes medications) except for those that need to be discontinued five days before the procedure such as aspirin and all anti-inflammatory medications (e.g. Motrin/ Ibuprofen, Aleve, Relafen, Daypro). These medicines may be re-started the day after the procedure. You may take your regular pain medicine as needed before/after the procedure. If you are taking Coumadin, Heparin, Lovenox, Plavix or Ticlid you must notify the office so that the timing of stopping these medications can be explained.
You must bring a driver with you. You may return to your current level of activities the next day including return to work.
Things that may Delay the Procedure
If you are on antibiotics please notify our office; we may delay the procedure. If you have an active infection or fever we will not do the procedure.