Intercostal nerve block (abbreviated ICNB) is a nerve block which temporarily or permanently interrupts the flow of signals along an intercostal nerve, usually performed to relieve pain.[1]
| Intercostal nerve block | |
|---|---|
 Intercostal nerves with the superficial muscles removed | |
| ICD-9-CM | 04.81 |
| MeSH | D009407 |
Uses
editAn ICNB relieves the pain associated with injured intercostal nerves. This pain can arise from chest surgery, physical trauma, aggravation of the shingles virus, or pressure put upon the nerves during pregnancy. [2]
Techniques
editAnesthetic nerve block
editInjecting local pain relievers and steroids into the injured area alleviates intercostal nerve pain.[2] In this type of nerve block, a needle inserted between two ribs releases a steroid into the area around the nerve. The exact location of injection depends on the underlying cause of the injury. After three to five days, the steroid begins to relieve pain. Depending on the individual, the pain-relieving effects of the steroid last for days to several months.[2]
Risks
editInjection without a device such as an ultrasound or fluoroscope to guide the needle can cause pneumothorax, a condition where air enters the cavity surrounding the lung or into a blood vessel causing local anesthetic toxicity.[3] Other newer facial plane blocks may be an alternative option due to a preferential safety profile [4]
Neurolysis
editPhysicians can also treat intercostal nerve pain by intentionally damaging the intercostal nerves. This process, known as neurolysis, prevents the nerves from sending pain signals.[2] In chemical neurolysis, a needle injects alcohol or phenol into the nerve and prevents the conduction of pain signals. Neurolysis can also be accomplished through a process known as radio-frequency lesioning.[2] In radio-frequency lesioning, a needle transmits radio waves to the nerve and interrupts regular pain signaling.[5]
Additional images
edit
References
edit- ^ Rathmell, James P. (2012). Atlas of Image-Guided Intervention in Regional Anesthesia and Pain Medicine. Lippincott Williams & Wilkins. p. 196. ISBN 9781451154429. Retrieved 15 September 2018.
- ^ a b c d e Olamikan, Sola; Gulati, Amitabh; Trescot, Andrea M. (2016), Trescot, Andrea M. (ed.), "Intercostal Nerve Entrapment: Chest Wall", Peripheral Nerve Entrapments, Cham: Springer International Publishing, pp. 279–290, doi:10.1007/978-3-319-27482-9_29, ISBN 978-3-319-27480-5, retrieved 2020-09-17
- ^ "Pneumothorax - Symptoms and causes". Mayo Clinic. Retrieved 2020-09-18.
- ^ White, L. D.; Riley, B.; Davis, K.; Thang, C.; Mitchell, A.; Abi-fares, C.; Basson, W.; Anstey, C. (2021). "Safety of Continuous Erector Spinae Catheters in Chest Trauma: A Retrospective Cohort Study". Anesthesia & Analgesia. 133 (5): 1296–1302. doi:10.1213/ANE.0000000000005730. hdl:10072/407871. ISSN 0003-2999. PMID 34473654. S2CID 234492181.
- ^ "Radiofrequency neurotomy - Mayo Clinic". www.mayoclinic.org. Retrieved 2020-09-18.
Further reading
edit- Richard S. Weinered. (2001). Pain Management: A Practical Guide for Clinicians, Sixth Edition CRC Press. p. 461 ISBN 0849309263
- Lennard, TA; Vivian, DG; Walkowski, SD; Singla, AK (2011). Pain procedures in clinical practice (3rd ed.). Philadelphia: Elsevier/Saunders. pp. 289–92. ISBN 978-1437737745.
- Erdine, P. Prithvi Raj, Serdar (13 August 2012). Pain-relieving procedures : the illustrated guide. Chichester, West Sussex: Wiley-Blackwell. pp. 14–27. ISBN 978-0470670385.
{{cite book}}: CS1 maint: multiple names: authors list (link) - Franco, KL; Putnam JB (1998). Advanced therapy in thoracic surgery. Hamilton, Ont.: B.C. Decker. pp. 4–8. ISBN 1550090445.
- Poon, Alan. "Intercostal nerve block". American Society of Regional and Pain Medicine. Archived from the original on 3 November 2014. Retrieved 1 January 2014.
- Bridenbaugh, PO; Cousins, MJ (1998). Neural blockade in clinical anesthesia and management of pain (3rd ed.). Philadelphia: Lippincott-Raven. pp. 457–63. ISBN 0397511590.
- Moore, Keith L. Moore, Anne M.R. Agur; in collaboration with and with content provided by Arthur F. Dalley II; with the expertise of medical illustrator Valerie Oxorn and the developmental assistance of Marion E. (2007). Essential clinical anatomy (3rd ed.). Baltimore, MD: Lippincott Williams & Wilkins. pp. 48–65. ISBN 978-0781762748.
{{cite book}}: CS1 maint: multiple names: authors list (link) - Benzon, HT; Rathmell, JP; Wu, CL; Turk, DC; Argoff CE (2008). Raj's practical management of pain (4th ed.). Philadelphia: Mosby-Elsevier. pp. 749–52. ISBN 978-0323070799.
- Ho, AM; Karmakar, MK; Critchley, LA (Aug 2011). "Acute pain management of patients with multiple fractured ribs: a focus on regional techniques". Current Opinion in Critical Care. 17 (4): 323–7. doi:10.1097/mcc.0b013e328348bf6f. PMID 21716105. S2CID 5206646.
- Karmakar, MK; Ho, AM (Mar 2003). "Acute pain management of patients with multiple fractured ribs". The Journal of Trauma. 54 (3): 615–25. doi:10.1097/01.ta.0000053197.40145.62. PMID 12634549.
- Waldman, Steven D. (2009). Atlas of interventional pain management (3rd ed.). Philadelphia, PA: Saunders/Elsevier. pp. 295–7. ISBN 978-1416099949.
- Moore DC, Bridenbaugh LD (1962). "Intercostal nerve block in 4333 patients: indications, technique, and complications". Anesth. Analg. 41: 1–11. doi:10.1213/00000539-196201000-00001. PMID 14475639.
- Tucker GT, Moore DC, Bridenbaugh PO, Bridenbaugh LD, Thompson GE (September 1972). "Systemic absorption of mepivacaine in commonly used regional block procedures". Anesthesiology. 37 (3): 277–87. doi:10.1097/00000542-197209000-00003. PMID 5051605. S2CID 38627773.
- Hidalgo, NRA; Ferrante FM (2007). Finucane, BT (ed.). Complications of regional anesthesia (2nd ed.). New York, N.Y.: Springer. pp. 111–4. ISBN 978-0387689043.
- Maddox TG (October 2002). "Adverse reactions to contrast material: recognition, prevention, and treatment". Am Fam Physician (Review). 66 (7): 1229–34. PMID 12387435.
External links
edit- An intercostal nerve block page on the Johns Hopkins School of Medicine website