Intercostal Nerve Block

The intercostal nerves run between the ribs and carry sensation from the chest and abdominal wall. An intercostal nerve block may be used for localised chest-wall or upper abdominal pain, including selected cases of pain following surgery, trauma or shingles, when a particular intercostal nerve is suspected to be involved.

With the patient positioned appropriately, the target nerve is identified using ultrasound or X-ray guidance. A fine needle is advanced close to the nerve and local anaesthetic, with or without corticosteroid depending on the clinical situation, is injected around it. Image guidance helps improve accuracy and reduce the chance of injury to nearby structures.

An intercostal block can provide diagnostic information as well as short-term pain relief. If the pain returns after an initially successful block, the response may support consideration of longer-acting treatments such as pulsed radiofrequency in selected patients. The expected duration of benefit depends on the underlying cause of the pain.