Intercostal Nerve Block

Intercostal Nerve Blocks work to decrease pain felt between the ribs for surgical procedures, rib fractures, and upper abdominal procedures. Each set of ribs have an artery, vein, and nerve running underneath the ribs.  Each intercostal block works to relieve pain in a band-like section, and can help decrease dependence on opioids and other pain medications. The intercostal nerves also innervate your diaphragm muscles, which control your breathing and ability for your lungs to expand appropriately. 

We perform intercostal block with either ultrasound guidance or x-ray (fluoroscopy) to minimize the chance of intravascular injection and pneumothorax and to increase the reliability of dermatomal coverage. The injection can be made closer to the vertebral column (and more proximal in the course of the nerve) with ultrasound guidance because palpation of the rib is less important than with an anatomic landmark approach. The patient will likely be awake for the procedure, as it is not very invasive, and will be provided a local anesthetic to ease pain from the injection.