Intercostal Nerve Block

An intercostal nerve block delivers local anesthetic (and sometimes steroid) adjacent to the intercostal nerves — the nerves that run along the underside of each rib and provide sensation to the chest wall and upper abdominal wall. These blocks are used for a variety of chest and rib pain conditions.

Conditions Treated

Post-Herpetic Neuralgia (Shingles Pain): The most common indication. Shingles (herpes zoster) often affects the thoracic dermatomes, causing burning, shooting pain along a rib — which can persist for months to years. Intercostal nerve blocks with steroid can significantly reduce PHN pain.

Post-Thoracotomy Pain Syndrome: Persistent chest wall pain after lung or cardiac surgery. The intercostal nerves can be injured during thoracotomy, resulting in chronic neuropathic pain at the surgical site.

Rib Fracture Pain: Acute or subacute rib fracture pain causing splinting and respiratory compromise. Nerve blocks allow deeper breathing and reduce the risk of pneumonia.

Costochondritis: Inflammation of the cartilage connecting the ribs to the sternum.

Mesothelioma Pain: Intercostal nerve blocks as part of a multimodal cancer pain management plan.

The Procedure

Under fluoroscopic or ultrasound guidance, Dr. Rubin targets the intercostal nerve at the inferior margin of the target rib(s). Local anesthetic (and steroid if appropriate) is injected at each level. Multiple ribs can be treated in a single session.

The procedure is well-tolerated. A temporary area of skin numbness on the chest wall confirms successful nerve blockade.

Safety Considerations

Pneumothorax (collapsed lung from needle puncture) is a rare but known risk of intercostal nerve blocks. Dr. Rubin's use of imaging guidance minimizes this risk. Patients are monitored after the procedure, and symptoms of pneumothorax (worsening shortness of breath, chest pain) are reviewed before discharge.

Contact Us

Call 516-492-3100 to discuss intercostal nerve blocks for chest wall pain, rib pain, or shingles pain.