A targeted block that numbs the nerves between the ribs to relieve chest wall pain from rib injuries, surgery, or chronic pain conditions.
An Intercostal Nerve Block is a medical procedure in which an anesthetic (and sometimes a steroid) is injected near the intercostal nerves, which are the nerves that run between the ribs. This block is primarily used to treat pain that originates from the chest or rib cage area, including conditions such as rib fractures, post-surgical pain, and certain types of chronic pain syndromes. By blocking the intercostal nerves, this procedure helps to interrupt pain signals from the chest wall and provides pain relief.
The intercostal nerves are small nerves that travel along the underside of each rib, running from the spine around to the front of the chest. They supply sensation to the skin, muscles, and tissues of the chest wall and upper abdomen. When these nerves become irritated or damaged from an injury, surgery, or certain medical conditions, the pain can be sharp, constant, and debilitating. It often worsens with breathing, coughing, laughing, or any movement that involves the rib cage.
An intercostal nerve block delivers medication directly to the affected nerves, providing relief at the source. The local anesthetic stops the pain signals immediately, while a corticosteroid (if included) helps reduce any inflammation around the nerve over the following days and weeks. For many patients with chest wall pain, this block can make an enormous difference in comfort and quality of life, especially when the pain is severe enough to interfere with breathing or sleep.
Intercostal nerve blocks are recommended for patients with pain originating from the chest wall or rib area. You may be a good candidate if you have:
This block is particularly useful when chest wall pain interferes with your ability to breathe deeply or cough effectively, which can increase the risk of pneumonia and other complications in patients recovering from rib injuries or chest surgery.
The procedure is typically performed in an outpatient setting and takes about 15 to 20 minutes.
You will be positioned either sitting upright or lying on your side, depending on which ribs are being treated. The skin over the targeted area is cleaned and sterilized.
Your doctor will identify the affected intercostal nerve or nerves based on the location of your pain. Using palpation of the rib landmarks and sometimes ultrasound guidance, a thin needle is directed to the area just beneath the lower edge of the rib, where the intercostal nerve, artery, and vein travel together in a small groove.
A local anesthetic (and sometimes a steroid) is then injected at each targeted level. Multiple levels may be treated in a single session if the pain spans several rib areas. You may feel brief pressure or stinging with each injection.
After the injections, the needles are removed and bandages are applied. You will be monitored briefly before being discharged.
Intercostal nerve blocks are covered by most insurance plans, including Medicare, when performed for documented chest wall pain. The cost depends on the number of levels treated. Our office will verify your benefits before the procedure.
Recovery from an intercostal nerve block is quick. Most patients can resume normal activities the same day.
You may notice immediate pain relief from the local anesthetic, which is a welcome change if you have been struggling with chest wall pain. The numbing effect typically lasts several hours. Some patients experience a temporary feeling of numbness or tingling in the skin over the treated area, which is normal.
Mild soreness at the injection sites is common for a day or two. Avoid strenuous upper body activity for 24 hours. Deep breathing exercises are encouraged, especially if your pain had been limiting your ability to take full breaths.
If a steroid was included, the anti-inflammatory effects develop over the following three to seven days.
Many patients experience significant relief from intercostal nerve blocks, especially for acute conditions like rib fractures or post-surgical pain.
The duration of relief depends on the underlying condition. For acute rib fractures, a single block or short series of blocks may provide enough relief to get through the healing period. For chronic conditions like post-herpetic neuralgia, multiple blocks may be needed, and the relief from each block may last weeks to months.
When combined with other treatments like physical therapy, breathing exercises, and appropriate medications, intercostal nerve blocks can play a key role in managing chest wall pain and preventing complications from shallow breathing.
Here is what to keep in mind before your intercostal nerve block:
Medications: Inform your doctor about all medications, especially blood thinners. Some may need to be paused.
Breathing: If your pain has been limiting your ability to breathe deeply, let your doctor know. Restoring normal breathing is one of the key goals of this procedure.
Allergies: Report allergies to local anesthetics, steroids, or any other medications.
Rare risks: One uncommon but important risk of intercostal nerve blocks is pneumothorax (a small collapse of the lung). Your doctor takes careful precautions to minimize this risk, and you will be monitored after the procedure. Let the office know right away if you develop sudden shortness of breath or chest tightness after going home.
Transportation: Having a driver is recommended, though some patients are able to drive themselves depending on the location treated.
Broken or bruised ribs cause sharp pain with every breath. An intercostal nerve block numbs the affected area and makes it possible to breathe deeply and cough effectively during healing.
Persistent pain after chest or breast surgery can linger for months. Blocking the intercostal nerves at the affected levels provides targeted relief at the source.
When rib or chest wall pain makes you breathe shallowly, your risk of pneumonia increases. An intercostal nerve block restores your ability to take full, deep breaths, which is one of the most important things you can do for your lungs during recovery.
Herpes zoster (shingles) and post-herpetic neuralgia often affect the chest wall along one or more rib levels. An intercostal block can provide welcome relief from the burning, stabbing pain that these conditions cause.
