Intercostal nerve block (abbreviated ICNB) is a
nerve block which temporarily or permanently interrupts the flow of signals along an
intercostal nerve, usually performed to relieve
pain.[1]
Uses
An ICNB relieves the pain associated with injured intercostal nerves. This pain can arise from chest surgery, physical trauma, aggravation of the
shingles virus, or pressure put upon the nerves during pregnancy. [2]
Techniques
Anesthetic nerve block
Injecting
local pain relievers and
steroids into the injured area alleviates intercostal nerve pain.[2] In this type of nerve block, a needle inserted between two ribs releases a steroid into the area around the nerve. The exact location of injection depends on the underlying cause of the injury. After three to five days, the steroid begins to relieve pain. Depending on the individual, the pain-relieving effects of the steroid last for days to several months.[2]
Risks
Injection without a device such as an
ultrasound or
fluoroscope to guide the needle can cause
pneumothorax, a condition where air enters the cavity surrounding the lung or into a blood vessel causing local anesthetic toxicity.[3] Other newer facial plane blocks may be an alternative option due to a preferential safety profile [4]
Neurolysis
Physicians can also treat intercostal nerve pain by intentionally damaging the intercostal nerves. This process, known as
neurolysis, prevents the nerves from sending pain signals.[2] In chemical neurolysis, a needle injects alcohol or
phenol into the nerve and prevents the conduction of pain signals. Neurolysis can also be accomplished through a process known as
radio-frequency lesioning.[2] In radio-frequency lesioning, a needle transmits radio waves to the nerve and interrupts regular pain signaling.[5]
Franco, KL; Putnam JB (1998). Advanced therapy in thoracic surgery. Hamilton, Ont.: B.C. Decker. pp. 4–8.
ISBN1550090445.
Poon, Alan.
"Intercostal nerve block". American Society of Regional and Pain Medicine. Archived from
the original on 3 November 2014. Retrieved 1 January 2014.
Moore, Keith L. Moore, Anne M.R. Agur; in collaboration with and with content provided by Arthur F. Dalley II; with the expertise of medical illustrator Valerie Oxorn and the developmental assistance of Marion E. (2007).
Essential clinical anatomy (3rd ed.). Baltimore, MD: Lippincott Williams & Wilkins. pp. 48–65.
ISBN978-0781762748.{{
cite book}}: CS1 maint: multiple names: authors list (
link)
Ho, AM; Karmakar, MK; Critchley, LA (Aug 2011). "Acute pain management of patients with multiple fractured ribs: a focus on regional techniques". Current Opinion in Critical Care. 17 (4): 323–7.
doi:
10.1097/mcc.0b013e328348bf6f.
PMID21716105.
S2CID5206646.