frequent procedures
 

INTERCOSTAL NERVE BLOCKS
INDICATIONS: Intercostal nerve blocks are useful in the treatment of pain originating and traveling along the intercostal nerve, or surrounding structures, and include rib fracture costochondritis, chondrosternal joint inflammation either from trauma or arthritis, and pain radiating from thoracic axial spine pathology with irritation of the adjacent intercostal nerve. Such pain can originate from facet joints or from the disk, as with disk bulge herniation or protrusion, or degenerative disk disease. It can also originate from tumor or metastasis. In addition to all this, peripheral neuroma, post incisional for instance, in the chest wall can also be treated with intercostal nerve blocks.

PROCEDURE: The actual procedure itself is done taking into consideration the reason or indication for this injection itself. If there is chondrosternal joint area pain and discomfort, a block in the area long the rib cage close to the chondrosternal joint and anterior or posterior axillary line, with local anesthesia and deposteroid could be beneficial. Such injection is usually done in a unilateral fashion in order to avoid trauma to both lungs in the rare case where a small, usually 2% pneumothorax, occurs from a needle puncture into the lung. Needle use for injection is usually a small needle (for instance 25G x 1.5 inch), and can be done blind, or with fluoroscopic guidance, depending on the body habitus of the patient concerned. Each rib may receive 1 cc or 2 cc of injectate to achieve analgesia.

CONTRAINDICATIONS: Anticoagulant therapy including Coumadin and Heparin are a contraindication. The patient must have discontinued Coumadin for three days prior to injection.

COMPLICATIONS: Pneumothorax and rarely intravascular injections because of increased uptake of local anesthetic when intercostal nerve blocks are done can be a complication. Pneumothorax is usually benign and consists of about 2% pneumothorax, which require hospitalization, when a 5-guage needle is used in a patient with a normal lung anatomy.

SEDATIVES: Sedatives are not required for this procedure. The patient is allowed to take their usual medications or routine medications prior to coming for this procedure.
 

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