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KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Abbreviations
- Intercostal nerve block (ICNB)
- Intercostal nerve (ICN)
Synonyms
- Rib block
- ICNB
Definitions
- Nerve block of ICN that results in somatic analgesia to anterolateral chest wall and upper midabdomen
- Useful for acute &/or chronic pain of chest wall and abdomen
- Can be performed under ultrasound guidance (USG) (most common) or fluoroscopic guidance (FSG)
- ICNB lasts ~ 4 hours due to high vascularity of region
- ICN originates as ventral ramus of spinal nerve as it emerges from vertebral foramen
- Upon emerging from vertebral foramen, ventral ramus (ICN) travels between endothoracic fascia and superior costotransverse ligament/internal intercostal membrane
- More distal at angle of rib, ICN travels between innermost intercostal muscle and internal intercostal muscle
- It gives off 2 main branches
- Lateral cutaneous branch: Provides sensory innervation to lateral chest wall
- Emerges anterior to midaxillary line and divides into anterior and posterior branch
- Anterior cutaneous branch: Provides sensory innervation to anterior chest wall, including sternum
- Emerges lateral to sternum and divides into lateral and medial branch
- Lateral cutaneous branch: Provides sensory innervation to lateral chest wall
- Nerve block of ICN that results in somatic analgesia to anterolateral chest wall and upper midabdomen
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Expected Outcome
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Selected References
- Baxter CS et al: Intercostal nerve block 2019
- Kang CM et al: Postoperative pain control by intercostal nerve block after augmentation mammoplasty. Aesthetic Plast Surg. 41(5):1031-6, 2017
- Hsieh MJ et al: Management of acute postoperative pain with continuous intercostal nerve block after single port video-assisted thoracoscopic anatomic resection. J Thorac Dis. 8(12):3563-71, 2016
- Gulati A et al: A retrospective review and treatment paradigm of interventional therapies for patients suffering from intractable thoracic chest wall pain in the oncologic population. Pain Med. 16(4):802-10, 2015
- Krediet AC et al: Different approaches to ultrasound-guided thoracic paravertebral block: an illustrated review. Anesthesiology. 123(2):459-74, 2015
- Hwang EG et al: Effectiveness of intercostal nerve block for management of pain in rib fracture patients. J Exerc Rehabil. 10(4):241-4, 2014
- Bhatia A et al: Review article: is ultrasound guidance advantageous for interventional pain management? A systematic review of chronic pain outcomes. Anesth Analg. 117(1):236-51, 2013
- Bhatia A et al: Comparison of anatomic landmarks and ultrasound guidance for intercostal nerve injections in cadavers. Reg Anesth Pain Med. 38(6):503-7, 2013
- Connelly NR et al: Use of ultrasound-guided cryotherapy for the management of chronic pain states. J Clin Anesth. 25(8):634-6, 2013
- Shankar H et al: Retrospective comparison of ultrasound and fluoroscopic image guidance for intercostal steroid injections. Pain Pract. 10(4):312-7, 2010
- Akkaya T et al: Chronic post-surgical pain. Agri. 21(1):1-9, 2009
- Byas-Smith MG et al: Ultrasound-guided intercostal nerve cryoablation. Anesth Analg. 103(4):1033-5, 2006
- Doi K et al: Intercostal nerve block with 5% tetracaine for chronic pain syndromes. J Clin Anesth. 14(1):39-41, 2002
- Green CR et al: The role of cryoanalgesia for chronic thoracic pain: results of a long-term follow up. J Natl Med Assoc. 94(8):716-20, 2002
- Science Direct: Intercostal blocks for thoracic and abdominal surgery. https://doi.org/10.1016/S1084-208X(98)80007-4. Published January 1998. Reviewed November 2019. Accessed November 2019.
- Huang TT et al: Outpatient breast surgery under intercostal block anesthesia. Plast Reconstr Surg. 63(3):299-303, 1979
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Abbreviations
- Intercostal nerve block (ICNB)
- Intercostal nerve (ICN)
Synonyms
- Rib block
- ICNB
Definitions
- Nerve block of ICN that results in somatic analgesia to anterolateral chest wall and upper midabdomen
- Useful for acute &/or chronic pain of chest wall and abdomen
- Can be performed under ultrasound guidance (USG) (most common) or fluoroscopic guidance (FSG)
- ICNB lasts ~ 4 hours due to high vascularity of region
- ICN originates as ventral ramus of spinal nerve as it emerges from vertebral foramen
- Upon emerging from vertebral foramen, ventral ramus (ICN) travels between endothoracic fascia and superior costotransverse ligament/internal intercostal membrane
- More distal at angle of rib, ICN travels between innermost intercostal muscle and internal intercostal muscle
- It gives off 2 main branches
- Lateral cutaneous branch: Provides sensory innervation to lateral chest wall
- Emerges anterior to midaxillary line and divides into anterior and posterior branch
- Anterior cutaneous branch: Provides sensory innervation to anterior chest wall, including sternum
- Emerges lateral to sternum and divides into lateral and medial branch
- Lateral cutaneous branch: Provides sensory innervation to lateral chest wall
- Nerve block of ICN that results in somatic analgesia to anterolateral chest wall and upper midabdomen
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Expected Outcome
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Selected References
- Baxter CS et al: Intercostal nerve block 2019
- Kang CM et al: Postoperative pain control by intercostal nerve block after augmentation mammoplasty. Aesthetic Plast Surg. 41(5):1031-6, 2017
- Hsieh MJ et al: Management of acute postoperative pain with continuous intercostal nerve block after single port video-assisted thoracoscopic anatomic resection. J Thorac Dis. 8(12):3563-71, 2016
- Gulati A et al: A retrospective review and treatment paradigm of interventional therapies for patients suffering from intractable thoracic chest wall pain in the oncologic population. Pain Med. 16(4):802-10, 2015
- Krediet AC et al: Different approaches to ultrasound-guided thoracic paravertebral block: an illustrated review. Anesthesiology. 123(2):459-74, 2015
- Hwang EG et al: Effectiveness of intercostal nerve block for management of pain in rib fracture patients. J Exerc Rehabil. 10(4):241-4, 2014
- Bhatia A et al: Review article: is ultrasound guidance advantageous for interventional pain management? A systematic review of chronic pain outcomes. Anesth Analg. 117(1):236-51, 2013
- Bhatia A et al: Comparison of anatomic landmarks and ultrasound guidance for intercostal nerve injections in cadavers. Reg Anesth Pain Med. 38(6):503-7, 2013
- Connelly NR et al: Use of ultrasound-guided cryotherapy for the management of chronic pain states. J Clin Anesth. 25(8):634-6, 2013
- Shankar H et al: Retrospective comparison of ultrasound and fluoroscopic image guidance for intercostal steroid injections. Pain Pract. 10(4):312-7, 2010
- Akkaya T et al: Chronic post-surgical pain. Agri. 21(1):1-9, 2009
- Byas-Smith MG et al: Ultrasound-guided intercostal nerve cryoablation. Anesth Analg. 103(4):1033-5, 2006
- Doi K et al: Intercostal nerve block with 5% tetracaine for chronic pain syndromes. J Clin Anesth. 14(1):39-41, 2002
- Green CR et al: The role of cryoanalgesia for chronic thoracic pain: results of a long-term follow up. J Natl Med Assoc. 94(8):716-20, 2002
- Science Direct: Intercostal blocks for thoracic and abdominal surgery. https://doi.org/10.1016/S1084-208X(98)80007-4. Published January 1998. Reviewed November 2019. Accessed November 2019.
- Huang TT et al: Outpatient breast surgery under intercostal block anesthesia. Plast Reconstr Surg. 63(3):299-303, 1979
