An intercostal nerve block is an injection of local anesthetic with or without steroid injected just under the rib where the intercostal nerve lies. An intercostal nerve block is typically ordered by your doctor for pain in the area of your ribs that comes after having surgery in that area, a rib fracture, herpes zoster (shingles) or an intercostal nerve entrapment. An intercostal nerve block may be diagnostic and/or therapeutic. One of three things may happen. 1. The pain does not go away – which means that the pain is probably not coming from the nerve(s) at the level(s) of the injection – this has diagnostic value. 2. The pain goes away and stays away for a few hours but the original pain comes back and doesn’t get better again. This would mean the block was also of diagnostic value – the pain is probably coming from the nerve(s) at the level of the injection(s), but the steroid, if used, was not of benefit. 3. The pain goes away after the block, the pain may come back later that day, but then the pain gets better again over the next few days. This means that the block was of therapeutic value – the steroid had a long lasting effect on the pain. If you get good, lasting benefit from the injection, the block may be repeated. It is hoped that each subsequent injection will last longer than the one before.
As the rib cage is designed to protect the lungs, there is a risk of collapsing the lung if the needle penetrates the lung. If severe, this could require the placement of a chest tube to re-inflate the lung. As with most procedures there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used.
Most people say the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure though everyone’s response to any procedure is individual. As the injection is near a nerve it is possible to get a temporary “electric shock” sensation.
After signing a consent form and checking your blood pressure the procedure will be done with you either in the sitting position or lying on the stretcher depending on the area to be injected as well as your comfort. You will be asked to rate your pain on a scale of 0 – 10. The doctor will feel your back to identify the rib(s) to be injected. The area will be cleansed with an antiseptic soap. Some local anesthetic may be placed under the skin – this is felt as a stinging/burning sensation. A small needle is then advanced to just under the rib. Local anesthetic, with or without steroid, is then injected and the needle is removed. This is repeated for as many levels as needed. When all levels are complete, your skin will be cleansed and a bandage(s) will be applied if needed. The local anesthetic takes about 10 minutes to begin to take effect. The doctor will check your skin to see if the areas injected are numb. On occasion, an injection will need to be repeated to block the nerve. You will be asked what your pain scale is on a scale of 0 –10. Your blood pressure will be checked and you will be discharged to leave with your ride after M.D. approves discharge.
After the local anesthetic takes effect, you will feel numb in a band-like fashion that follows the rib(s). Your pain may be improved. It is important to keep track of how you feel for the remainder of the day. The steroid, when used, usually takes two or three days to have an effect in most people and peaks in about two weeks. You may feel lightheaded from the local anesthetic. This is usually short-lived. Some local tenderness may be experienced for a couple of days after the injection. Using an ice pack three or four times a day will help this. You make take your pain medication as well after the injection. It is important to keep track of the amount of pain relief you received as well as how long the pain relief lasted.
You may NOT drive for the remainder of the day after your procedure. No heat is to be used on the injection area for the remainder of the day. No tub bath or soaking in water (pools/Jacuzzi, etc) for the remainder of the day.
If you experience severe back pain, new numbness or weakness of your legs, loss of control of your bladder or bowels, or have signs of infection (temperature greater than 99.9º , drainage, redness/heat at insertion site) – call IMMEDIATELY.
ON THE DAY OF YOUR PROCEDURE, PLEASE DO THE FOLLOWING:
♦ Take all blood pressure pills & heart medications prior to the procedure with a sip of water at least 3 hours before your requested arrival time. Your vitals must be stable to have the procedure.
♦ Have a responsible person to take you home.
♦ Arrive at the requested procedure time. Please do not be late or your procedure may be cancelled.
ON THE DAY OF YOUR PROCEDURE:
♦ Do not take ANY of the following 5 days before your procedure: Coumadin
♦ Do not take ANY of the following 7 days before your procedure: Plavix
♦ Coumadin must be stopped prior to the injection. You must have a normal INR prior to the injection. Do not stop the drug by yourself.
♦ Eat or drink 6 hours before the procedure.
NOTE: YOUR PROCEDURE WILL BE CANCELLED IF:
- You have an active infection, flu, cold, fever, or very high blood pressure.
- You do not have a responsible driver to take you home, arrive late for your procedure, or unable to follow the medication / fluid restrictions.
Call the office at (513) 860-1039 for procedure related questions.