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Procedure: Intercostal Nerve Block

What is an 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 the patient’s pre-op and recovery time as well.  The patient’s driver must remain in the building during the 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). While there is some discomfort involved, the skin and deeper tissues are numbed with a local anesthetic using a very thin needle prior to the performance of the block. Monitored Anesthesia Care (MAC) makes the procedure easy to tolerate.


Will I be “Put Out” for this procedure?

This procedure can be done under local  or general sedation.  If the patient does not feel comfortable with just the numbing medication, Coastal Bend Pain Management can give 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 performed.


What should I expect after the injection?

Due to the local anesthetic injected during the procedure, patient might notice their pain may be gone or quite less. The patient may also feel sore and/or have an increase in pain for two to three days due to the mechanical process of needle insertion as well as initial irritation from the steroid itself.  Patient should start to notice pain relief within three to seven days.


What should I do after the procedure?

The patient should have a driver take them home. Coastal Bend Pain Management advises patients to take it easy the day of the procedure. The patient may apply ice to the affected area and perform activities as tolerated.


Can I go back to work the next day?

Yes, the patient 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 patient's symptoms in about a week or two, they may be recommended to come in for an office visit to discuss further options or have one more injection. Generally we do not repeat injections that do not help patient's symptoms. Patients 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, the patient feels winded or cannot seem to catch their 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 the patient's lung has collapsed.


Who should not have this injection?

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

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