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intercostal nerve block

INTRODUCTION

Your doctor has discussed an intercostal nerve block with you. This brochure provides you with information on an intercostal block. For general information about a nerve block, please consult the Nerve Block brochure.

WHAT IS AN INTERCOSTAL BLOCK?

Under each rib, a nerve runs that provides sensation in the area around this rib. This nerve is called the intercostal (= between rib) nerve. A human has 12 ribs on each side of the chest and thus 12 intercostal nerves, both left and right. 

If it is suspected that one of these nerves plays a role in your pain, for example, lung pain after lung surgery, an intercostal nerve block can be considered but one or more test (diagnostic) blocks are required first.

WHAT IS THE DIFFERENCE BETWEEN A TRIAL BLOCK AND A LONG-ACTING BLOCK?

The anesthesiologist/pain management specialist first uses test blocks to determine whether the intercostal nerve is involved in the pain. It must also be determined which of the 12 nerves is the cause of the pain. A test block is a temporary, diagnostic block with a short-acting anesthetic (like you would receive at the dentist). Treatment with a longer duration of effect is only used if pain relief occurs after a test block but this usually cannot be done on the same day. 

Sometimes the anesthesiologist/pain management specialist might immediately decide to perform a long-acting block. Your doctor will always discuss this with you in advance.

PREPARATION

  • If you are taking anticoagulants (also known as blood thinners) (e.g. Sintrom, Marcoumar or Acenocoumarol, Rivaroxaban, or Dabigatran), you must stop before the treatment. Please consult your Anesthesiologist/Pain Management Specialist to find out how far in advance you should stop.
  • Inform the Anesthesiologist/Pain Management Specialist of allergies or hypersensitivities to X-Ray contrast fluid.
  • The treatment almost always takes place as an Outpatient (Day Care) procedure. Do keep in mind that after the procedure you are NOT allowed to drive home yourself because, after the block, there may be a temporary loss of strength or sensation.
  • You are typically allowed to eat, drink and take your other medication as usual. If you do need to be fasting, the Specialist will discuss this with you in advance.
  •  If you are pregnant or think you may be, the treatment cannot take place.
  • The treatment is done under local anesthetic and takes about 15 minutes. After the treatment has been administered, you will be taken to the recovery room for half an hour before you are allowed to go home.
  • If you have a fever on the day of treatment, unfortunately, the treatment cannot proceed as scheduled on that day. Please contact the Outpatient Department using the contact information on the back of this brochure as soon as possible!

PROCEDURE

You will lie on your stomach during the treatment and the anesthesiologist gives a local anesthetic at the site of the nerve to be treated. Using fluoroscopy (or ultrasound), a needle is placed just below the associated rib. In the case of a test block, we check the correct position of the needle with X-ray contrast liquid. The anesthetic is then injected and the result of a test block is clear within 30 minutes to an hour. With a long-acting block, there are 3 options:

  1. Controlling the needle position with X-ray contrast fluid followed by treatment with drugs containing corticosteroids (anti-inflammatories);
  2. Determining the correct position of the needle using an electric current. When the needle is in the correct position, the tip of the needle is electrically heated for longer operation;
  3. A combination of the above techniques

It may take a few days to weeks before you notice whether the treatment has had an effect and sometimes additional treatment is needed.

SIDE EFFECTS

Side effects that can occur are:

  • Bruising or muscle pain at the puncture site. The muscle pain can last for a few days however you can use paracetamol for this if necessary.
  • Side effects of the corticosteroids, such as elevated blood sugars in patients with diabetes.

COMPLICATIONS

The treatment is carried out carefully and rarely leads to unwanted, permanent damage. The anesthesiologist/pain management specialist will consult with you if the treatment carries special risks for you. 

A serious but uncommon complication is the development of a collapsed lung. Signs of this include coughing, chest pain, and/or shortness of breath. This can occur up to 24 hours after treatment. If you experience these symptoms after treatment, you should go to the emergency room right away where a chest X-ray will be taken to confirm the diagnosis.

ADDITIONAL INFORMATION

If you have any questions or if you would like more information, please contact the Outpatient Department using the information at the back of this brochure. 

  • The Policlinic days are Tuesdays and Wednesdays.