A block of the nerves running along the underside of the ribs.
What is an intercostal nerve block?
Each intercostal nerve runs in a groove under its rib. Blocking it relieves pain in the matching band of chest or belly wall.
What we use it for
- Rib fractures and chest wall injury after a collision
- Post-herpetic neuralgia in a chest wall distribution
- Chest wall pain that has not settled
- Post-surgical chest wall pain
What happens during an intercostal nerve block?
- Ultrasound-guided, about 15 minutes.
- Relief is often immediate.
- Breathing usually becomes easier straight away where rib pain was limiting it.
What are the risks of an intercostal nerve block?
The specific risk is pneumothorax, a puncture of the lung. The reason is that the nerve runs right below each rib, with the pleura (the thin lining of the lung) just beneath it. Ultrasound guidance lowers that risk a great deal but does not remove it. That is why sudden breathlessness or sharp chest pain afterward needs urgent assessment. Local anesthetic soaks quickly into the blood in this area, which has many blood vessels. So the total dose is limited when several levels are treated.
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How we judge whether it worked
Relief is usually immediate. The clearest test is your breathing: being able to take a deep breath again.
That matters more than comfort. Pain that stops deep breathing after a rib injury lets mucus build up in the lungs, and that leads to chest infection. So this block does more than ease pain.
Before and after your procedure
No sedation is used, so most patients drive themselves home, and they may return to normal activity, including work, within two to four hours. The key instruction is what to watch for afterward. Sudden breathlessness or sharp chest pain needs urgent assessment, because puncture of the lung, though uncommon, is the specific risk here. Use the relief to breathe deeply and cough. That is what prevents a chest infection after a rib injury.
How is an intercostal nerve block done?
The intercostal nerves run along the underside of each rib. The block is placed just below the edge of the rib under ultrasound guidance. That lets us see the pleura and stay clear of it. A small volume of anesthetic, sometimes with steroid, is placed around the nerve. It is a short procedure. The numbness that follows over that strip of chest wall confirms the needle was in the right place.
Who is an intercostal nerve block for?
It suits rib fracture pain and chest wall pain after surgery, including after thoracotomy (surgery through the chest wall). It also suits post-herpetic neuralgia (nerve pain after shingles) across the chest, and chest wall pain whose source needs confirming. It is not right when the pain is visceral (coming from the organs) rather than from the chest wall. That is why heart and belly causes are ruled out first, not afterward.
Where this sits in the sequence
Nothing here is offered as a first move on its own. The order runs like this: history, then exam, then imaging when it will change something. Then comes a targeted procedure when the exam points somewhere specific. Skipping to the procedure is how patients end up with a series of injections and no more answers at the end than at the start. When a step will not change the plan, we say so and skip it.
Common questions
Is it safe with rib fractures?
It is one of the more useful treatments for them, because pain that stops deep breathing is what leads to chest infections.
Is there a risk to the lung?
It is the known risk. That is why the block is done under ultrasound, with the pleura in view. The risk is low with guidance and careful technique.
How do you know my pain is from the chest wall?
Chest wall pain can usually be brought on by pressing on one spot. It also changes with movement or breathing. Anything suggesting a heart or internal cause is investigated first.
Can it be repeated?
Yes, when it helps and the problem underneath is still settling, such as healing rib fractures.
Can a nerve block help rib pain?
Yes. Each intercostal nerve runs in a groove under its rib, so numbing it quiets pain across that band of the chest wall. Relief is often immediate, and breathing usually gets easier right away. That matters after a rib fracture: pain that stops deep breaths and coughing is what leads to chest infection. The block can be repeated while the fractures heal.
Sources
- Guerra-Londono CE et al. Assessment of Intercostal Nerve Block Analgesia for Thoracic Surgery: A Systematic Review and Meta-analysis. JAMA network open, 2021. PubMed 34779845
- Ajmal S et al. The Role of Multilevel Intercostal Nerve Block in Local Anesthetic Thoracoscopy. Journal of bronchology & interventional pulmonology, 2024. PubMed 37438892
- Expert Panel on Thoracic Imaging et al. ACR Appropriateness Criteria® Nontraumatic Chest Wall Pain. Journal of the American College of Radiology : JACR, 2021. PubMed 34794596
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