Medicine:Intercostal nerve block

Short description: Procedure for pain relief

Intercostal nerve block
Intercostal nerves with the superficial muscles removed
ICD-9-CM	04.81
MeSH	D009407

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.

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.

Techniques

Anesthetic nerve block

Injecting local pain relievers and steroids into the injured area alleviates intercostal nerve pain. 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.

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. Other newer facial plane blocks may be an alternative option due to a preferential safety profile

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. 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. In radio-frequency lesioning, a needle transmits radio waves to the nerve and interrupts regular pain signaling.

Additional images

An intercostal nerve and its branches

Further reading

• Richard S. Weinered. (2001). Pain Management: A Practical Guide for Clinicians, Sixth Edition CRC Press. p. 461 ISBN:0849309263
• Lennard, TA; Vivian, DG; Walkowski, SD; Singla, AK (2011). Pain procedures in clinical practice (3rd ed.). Philadelphia: Elsevier/Saunders. pp. 289–92. ISBN 978-1437737745. https://books.google.com/books?id=JNpNeW05rLIC. 
• Erdine, P. Prithvi Raj, Serdar (13 August 2012). Pain-relieving procedures : the illustrated guide. Chichester, West Sussex: Wiley-Blackwell. pp. 14–27. ISBN 978-0470670385. https://books.google.com/books?id=jDFIYgEACAAJ. 
• Franco, KL; Putnam JB (1998). Advanced therapy in thoracic surgery. Hamilton, Ont.: B.C. Decker. pp. 4–8. ISBN 1550090445. 
• Poon, Alan. "Intercostal nerve block". American Society of Regional and Pain Medicine. http://www.asra.com/pain-resource-center-regional-anesthesia-intercostal-nerve-block.php. 
• Bridenbaugh, PO; Cousins, MJ (1998). Neural blockade in clinical anesthesia and management of pain (3rd ed.). Philadelphia: Lippincott-Raven. pp. 457–63. ISBN 0397511590. https://books.google.com/books?id=jvema9PNEPgC. 
• 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. ISBN 978-0781762748. https://books.google.com/books?id=Xz8F00Su2SwC. 
• Benzon, HT; Rathmell, JP; Wu, CL; Turk, DC; Argoff CE (2008). Raj's practical management of pain (4th ed.). Philadelphia: Mosby-Elsevier. pp. 749–52. ISBN 978-0323070799. https://books.google.com/books?id=Ca2AMBxR3GEC&pg=RA9-PT2849. 
• 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. PMID 21716105. 
• Karmakar, MK; Ho, AM (Mar 2003). "Acute pain management of patients with multiple fractured ribs.". The Journal of Trauma 54 (3): 615–25. doi:10.1097/01.ta.0000053197.40145.62. PMID 12634549. 
• Waldman, Steven D. (2009). Atlas of interventional pain management (3rd ed.). Philadelphia, PA: Saunders/Elsevier. pp. 295–7. ISBN 978-1416099949. 
• "Intercostal nerve block in 4333 patients: indications, technique, and complications". Anesth. Analg. 41: 1–11. 1962. doi:10.1213/00000539-196201000-00001. PMID 14475639. 
• "Systemic absorption of mepivacaine in commonly used regional block procedures". Anesthesiology 37 (3): 277–87. September 1972. doi:10.1097/00000542-197209000-00003. PMID 5051605. 
• Hidalgo, NRA; Ferrante FM (2007). Finucane, BT. ed. Complications of regional anesthesia (2nd ed.). New York, N.Y.: Springer. pp. 111–4. ISBN 978-0387689043. https://books.google.com/books?id=GJhv7Sh1Mu0C&pg=PA111. 
• Maddox TG (October 2002). "Adverse reactions to contrast material: recognition, prevention, and treatment". Am Fam Physician 66 (7): 1229–34. PMID 12387435. http://www.aafp.org/afp/2002/1001/p1229.html. 

External links

• An intercostal nerve block page on the Johns Hopkins School of Medicine website