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INTRODUCTION

The intercostal nerve block was first described in 1907 by Heinrich Braun1 to treat acute and chronic pain of the posterior and anterior portions of the superficial thorax and upper abdomen. The intercostal nerves are mixed nerves of with motor and sensory components. Elaborate on the function of the ICN.

INDICATIONS

Intercostal blocks are useful in relieving post-traumatic and postoperative pain, and more recently, chronic nonmalignant and from malignancies processes involving the thoracic wall (Table 57-1).2, 3, and 4 Blockade of the intercostal nerve may ameliorate painful nerve impulses associated with chronic neuropathic pain. Local anesthetic blocks can also be used to diagnose pain problems when both thoracic and visceral sources are suspected. Similar techniques can be used to perform neurolysis (cryoablation, radiofrequency ablation, or chemical neurolysis).

TABLE 57-1.Indications for Intercostal Nerve Blocks3,5,6

CONTRAINDICATIONS

While there are few absolute contraindications to an intercostal nerve block, extra caution must be taken in patients to whom a pneumothorax may be detrimental. These patients may include:

  • Respiratory decompensated patients

  • Patients with a single lung on the side of the planned procedure

  • Patients on positive pressure ventilations

  • Postsurgical patients

General relative contraindications include blood dyscrasias, local or uncontrolled systemic infection, or unknown anatomical changes (eg, unknown rib resection).

Advantages

As with other regional techniques, intercostal nerve blocks are associated with:

  • Decreased need for parenteral or oral opioids.3,5

  • In thoracic surgery, the use of intercostal nerve blocks allows for improved respiratory function in FEV1 and Peak expiratory flow rate.5,7

  • Decreasing oral or parental opioids may reduce the incidence of nausea, vomiting, urinary retention, itching, and hypotension.

Complications

While complication rates vary, performing the block with imaging may reduce some of the associated risks described below (Table 57-2).

TABLE 57-2.Complications Associated with Intercostal Nerve Blocks3

ANATOMY

The intercostal nerve travels ...

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