What is an intercostal nerve block?
An intercostal nerve block is an injection of local anaesthetic around the ribs of the chest. The ribs and muscles between them make up the chest wall. An injection here numbs the nerves that go to part of the chest wall. The word ‘costa’ refers to your ribs. The word ‘inter’ means between, hence the name intercostal nerve block.
This is one of many types of nerve block. This particular nerve block is usually used as part of an anaesthetic for an operation on the chest.
The nerve block may be used with a general anaesthetic, in which case you will be asleep for the nerve block. If the block is instead of a general anaesthetic, you will be awake, or sedated (sleepy). This is not commonly done.
The block usually lasts for several hours, so that your chest will be numb during this time. One advantage of the block is that it reduces the amount of other strong painkillers, such as morphine, needed during and after the operation.
The aim is that you feel no pain during your operation. The block will provide pain relief during the operation and for several hours afterwards. Your anaesthetist will talk to you before doing the block and explain whether you will be awake, asleep or sedated during the operation.
There are a number of benefits. You may have other serious medical conditions, such as heart or lung disease. In this case a general anaesthetic may have slightly more risk than normal. Having the block, instead of a general anaesthetic, will cause less stress to your medical condition and be safer.
It is more common to perform a nerve block with a general anaesthetic. This gives excellent pain relief both during and after surgery. This means that the anaesthetist does not need to give as much anaesthetic or strong painkillers. This means a faster recovery and less sickness after the operation.
Are there any alternatives?
There are several alternatives to an intercostal nerve block. These are:
General anaesthetic: You can have your general anaesthetic, where you are completely asleep throughout, but without the intercostal nerve block. Other strong painkillers, such as morphine, can be given to keep you comfortable when you wake up.
Epidural: It may be possible to perform an epidural where the chest wall is made numb and is pain free. This involves placing a plastic tube next to the nerves in the spine, so that drugs can be injected, making the nerves stop working temporarily.
Local anaesthetic: Sometimes, if the surgery is minor, local anaesthetic injections can be used to numb the operation area only.
If you are to have one of these procedures there is another information leaflet that will tell you more about it.
Who should have it done?
Patients who are having an operation on their chest wall can have this type of anaesthetic. The second main use of the block is for people having surgery inside the chest. Such an operation would be one where part of the lung is removed. The area of the chest that is cut open may be very painful. This block reduces the pain.
Who should not have it done?
Each patient has the final decision to proceed or not. If you are unhappy about the procedure for any reason, you should not continue. There are specific medical situations when an intercostal nerve block should not be done and they are as follows:
Medication that prevents your blood from clotting, such as Warfarin; this would lead to more bleeding than normal. Bleeding around the nerves in the chest is a serious problem and must be avoided.
An illness that prevents your blood from clotting, such as haemophilia; this would lead to more bleeding around the nerves in the chest.
Infection of the skin over the site where the needle needs to be put in; this could lead to further infection in the deeper tissues and possibly blood poisoning. This could also cause infection around the nerves.
Unusual or difficult anatomy; this would make it difficult to put the needle in the correct place.
Previous injury or disease affecting the chest. Perhaps you have had a previous injury to your back or chest.
Author: Dr Sean White FRCA. Consultant in pain and anaesthesia
© Dumas Ltd 2006