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
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
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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Related Differential Diagnoses
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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
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
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
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