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Intercostal Nerve Block

What is an intercostal nerve block?

An intercostal nerve block is an injection of medication that helps relieve pain in the chest area caused by a herpes zoster infection (or “shingles”) or a surgical incision.

Intercostal nerves are located under each rib. When one of these nerves or the tissue around it gets irritated or inflamed, it can cause pain. A steroid medication and local anesthetic injected under the rib can help reduce the inflammation and alleviate the pain.

Intercostal nerve blocks also can be used to help diagnose the source of pain.

How is an intercostal nerve block done?

First, you’ll be given an intravenous medication to relax you. Then, you’ll lie on your side — the one not causing pain.

The doctor will use antiseptic to clean an area of skin near your ribs. Then he or she will:

  • Insert a thin needle under your rib and inject anesthetic
  • Use x-ray guidance to insert a second needle and inject a steroid pain medication

Usually, the procedure takes less than 30 minutes, and you can go home the same day.

How effective is an intercostal nerve block?

Some patients report pain relief immediately after the injection, but the pain may return a few hours later as the anesthetic wears off. Longer term relief usually begins in two to three days, once the steroid begins to work.

How long the pain relief lasts is different for each patient. For some, the relief lasts several months. If the treatment works for you, you can have periodic injections to stay pain-free.

What are the risks?

The risk of complication from an intercostal nerve block is very low. However, there could be bruising or soreness at the injection site. Serious complications, including infection, collapsed lung, nerve damage and bleeding, are uncommon.

What happens after the procedure?

Do not drive or do any rigorous activity for 24 hours after your intercostal nerve block. Take it easy. You can return to your normal activities the next day.

You can continue your regular diet and medications immediately.

Is an intercostal nerve block right for you?

An intercostal nerve block may be right for you if you have a recent onset of pain in the chest area — especially due to shingles or a surgical incision — which does not respond to other treatment.

Talk to your physician about it. To schedule an evaluation at Cleveland Clinic’s Department of Pain Management call 216.444.PAIN (7246) or 800.392.3353.