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Intercostal Nerve Blocks for Chest Wall Pain and Rib Fractures
What is Intercostal Nerve Blocks for Chest Wall Pain and Rib Fractures?
Intercostal nerve blocks are procedures that are performed to relieve pain. While there are many applications for intercostal nerve blocks, in this article we shall discuss its role in managing chest wall pain and rib fractures. The commonly used drugs in this procedure include a local anesthetic agent which numbs the nerve, along with a steroid agent which reduces inflammation and pain.
Who needs Intercostal Nerve Blocks for Chest Wall Pain and Rib Fractures?
From the spinal cord, a number of nerves arise that wind around the chest under the ribs and supply the skin and the muscles between the ribs. The muscles between the ribs are called intercostal muscles. The nerves that supply these are called the intercostal nerves.
In cases of conditions such as rib fractures, pain can arise due to the irritation and injury of the intercostal nerves. Blocking the conduction of pain impulses through these nerves with the help of certain drugs or toxins can help relieve the pain. This is called an intercostal nerve block.
What are the steps in Intercostal Nerve Blocks for Chest Wall Pain and Rib Fractures?
Isolating the Nerve
Before the procedure is performed, the exact nerve that needs to be blocked has to be isolated. In order to do this, patients may require certain investigations, such as a chest x-ray to look for sites of injury and to aid the doctor to mark the spot on the chest wall where the injection needs to be given.
Positioning the Patient
Once the spot is identified, the patient is placed in a position where it is easy to access the site where the injection needs to be administered. This can involve the patient lying down on their chest or on their sides or even sitting up. The doctor may have a feel of the area to accurately mark the spot where the needle needs to be inserted.
Administering the Injection
Once the spot where the injection needs to be administered is confirmed, the skin is cleaned with an antiseptic solution and the injection is administered.
The procedure by itself takes no more than a few minutes to perform depending on the number of injections that are required. In most cases, immediately after the procedure, patients will experience a significant reduction in pain. This is primarily due to the local anesthetic injection and can pass after a few hours. The overall effect in pain reduction, which lasts a lot longer, usually kicks in a couple of days after the injection has been administered. The effects can last for up to a few months. Patients may require repeat injections if the pain does not subside over time.
As with any procedure, there are few risks. The most common risk is that of mild bruising at the site of injection and sometimes pain at the site of injection. These are usually relieved in a day or two. In most cases, there is no need for taking any bed rest, and patients can resume their normal activities the day after the procedure. Other less common risks include infection at the site of injection and an allergic reaction to the drugs administered.