Intercostal nerve block

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]

Intercostal nerve block
Intercostal nerves with the superficial muscles removed
ICD-9-CM04.81
MeSHD009407

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]

Additional images
An intercostal nerve and its branches

References
  1. Rathmell, James P. (2012). Atlas of Image-Guided Intervention in Regional Anesthesia and Pain Medicine. Lippincott Williams & Wilkins. p. 196. ISBN 9781451154429. Retrieved 15 September 2018.
  2. Olamikan, Sola; Gulati, Amitabh; Trescot, Andrea M. (2016), Trescot, Andrea M. (ed.), "Intercostal Nerve Entrapment: Chest Wall", Peripheral Nerve Entrapments, Cham: Springer International Publishing, pp. 279–290, doi:10.1007/978-3-319-27482-9_29, ISBN 978-3-319-27480-5, retrieved 2020-09-17
  3. "Pneumothorax - Symptoms and causes". Mayo Clinic. Retrieved 2020-09-18.
  4. White, L. D.; Riley, B.; Davis, K.; Thang, C.; Mitchell, A.; Abi-fares, C.; Basson, W.; Anstey, C. "Safety of Continuous Erector Spinae Catheters in Chest Trauma: A Retrospective Cohort Study". Anesthesia & Analgesia: 10.1213/ANE.0000000000005730. doi:10.1213/ANE.0000000000005730. hdl:10072/407871. ISSN 0003-2999.
  5. "Radiofrequency neurotomy - Mayo Clinic". www.mayoclinic.org. Retrieved 2020-09-18.

Further reading
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