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Intercostal Nerves Block and RFA

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Intercostal nerve block is a procedure used to treat pain in the chest and upper abdomen areas. An intercostal nerve block is a block of nerves that lie underneath the lower edge of each rib.

The intercostal nerve is found between ribs throughout the thoracic region. Injecting anesthetics, steroids, or other medications inhibits the transmission of pain signals and reduces inflammation of these nerves. This procedure may also be used to diagnose pain and identify the route of the pain signal. Conditions treated with the intercostal nerve block include:

• Neuropathic pain in the chest associated with herpes zoster or shingles.

• Chronic pain after mastectomy.

• Rib fracture pain.

• Pain related to the formation of scar tissue after surgery.

• Somatic pain secondary to metastatic cancer to the ribs.

Fluoroscope guidance using X-ray helps the doctor determine the correct placement of the needle. Once correct placement is verified, the nerve block injection is administered. A successful block is marked by pain relief. During the procedure, one nerve site may be blocked, or the injection may be performed at different sites along the nerve.

Intercostal nerve block is a short outpatient procedure that is capable of relieving pain of the muscles, bones, and skin in the chest and upper abdomen. Patients suffering from difficult to treat neuropathic or metastatic bone cancer pain may find an intercostal nerve block reduces their pain or relieves it completely. If the procedure is successful, the patient is a candidate for repeat injections to treat recurring pain.

The use of fluoroscopy in identifying proper needle placement greatly reduces the risk of pneumothorax and damage to surrounding tissues.

The first nerve block functions as a test as well as a possible treatment for pain. If the block results in pain relief, the physician can identify the role of the intercostal nerve in the patient’s condition. After a successful block, pain relief varies from patient to patient. Those being treated for acute pain tend to respond better to the nerve block than chronic pain sufferers. The anesthetic provides immediate pain relief that lasts a few hours. It takes longer for the steroid component to reduce inflammation and relieve pain. The steroid takes effect in about three to five days and can continue to provide pain relief for weeks or months. Patients who respond positively to treatment may receive repeat injections over time to prolong pain relief. Once the role of the intercostal nerve is identified, a permanent ablation may be performed to provide long-term pain relief.

The procedure is relatively low risk. Less than 1% of patients experience pneumothorax. This minimally-invasive treatment for pain that is often resistant to other medical interventions is easy for the patient to tolerate with minimal discomfort. If effective, the block allows patients to be more physically active in activities of daily living and improves quality of life.

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