What is an Intercostal Nerve Block?

• The intercostal nerves are the projections from the first 11 thoracic spinal nerves which run along the ribs.
• Intercostal nerve blocks are used to treat unresolved post-thoracotomy pain, or pain from herpes zoster (shingles), or to diagnose abdominal pain versus abdominal wall pain.
• An intercostal nerve block involves the injection of local anaesthetic and steroid onto a branch of the intercostal nerve, which is located to the side of the ribs.
• The steroid (Kenacort) reduces inflammation, irritation and swelling around the intercostal nerve.
• The procedure is performed in the day surgery using an X-ray machine.

Prior to the Procedure

• All blood thinning products (except aspirin) must be stopped prior to your procedure. You will be advised by letter when to stop taking these medications at the time that your admission date is arranged.
• You are able to take your other regular medications with a sip of water on the morning of your procedure.
• If you are an insulin dependent diabetic you will always be at the beginning of the list. Please bring your insulin with you and it will be given to you following your procedure.
• Hamilton Day Surgery Centre staff will advise you of your fasting and admission times.
• You must not have anything to eat, drink, smoke or chew prior to your procedure.
• You will need to organise someone to drive you home after the procedure as you will not be able to drive for 24 hours after your procedure.

What Will Happen?

1. You will be admitted to the day surgery by a nurse and you will be asked to change into a gown.
2. The anaesthetist will speak with you and place a cannula (plastic needle) into a vein in your hand.
3. In the procedure room, you will be assisted to position on the procedure table lying on your abdomen with a pillow under your hips and abdomen.
4. The anaesthetist will give you some sedation into your vein.
5. An X-ray machine will be used to determine where the doctor will place the needle for your procedure.
6. Steroid (Kenacort) and local anaesthetic will be injected once correct placement has been established with use of X-ray (Omnipaque). The procedure will take approximately 5 minutes to complete.
7. After the procedure, you will be placed on a trolley and taken to recovery, where you will remain for approximately 1 hour.
8. After having something to eat and drink, you will be discharged with a carer.

Post Procedure

• Gentle activity and rest is recommended in the first 24 hours following the procedure. You may then return to normal activity.
• The local anaesthetic will wear off 12-18 hours following your procedure.
• The steroid will take approximately 48 hours to start working. During this time there may be a window of increased discomfort or pain.
• Should you experience any chest pain and/or shortness of breath after your discharge, you should go to your nearest emergency department.
• A chest X-ray will be attended to ensure that you have not developed a pneumothorax (a small puncture of the lining of the lung).
• A nurse from HPC will telephone you 24 to 48 hours following your procedure to check on your progress and organise a follow-up appointment.
• You may obtain between 1 - 6 months of pain relief following your procedure.

If you require further explanation of the procedure, please contact Hunter Pain Specialists nursing staff on (02) 4985 1800.