c. Intercostal Nerve Block for Rib Metastases

Intercostal nerve block for rib metastases

What is an intercostal nerve block, what is its purpose, and how does it work?

The nerve that goes to the ribs is called the intercostal nerve. Unbearable pain can arise from rib fractures or when cancer spreads to the ribs. Patients particularly complain of severe pain while breathing. Just behind the rib, the nerves of the rib are located. In this case, similar to the destruction of dental nerves, the rib nerves can be temporarily blocked. This makes it possible for the patient to not feel the pain from fractures or cancer.

Intercostal nerves

What preparations are needed before an intercostal nerve block?

Before the intercostal nerve block, as much preparation as other interventional methods is not necessary. However, still:

• Ask your doctor to explain the procedure in detail before the intercostal nerve block. Your doctor will require written consent from you, as required by law.

• Inform your doctor about all other health conditions, medications you are taking, and if you have any, factors and medications that cause allergies. Herbal medications like vitamin E, glucosamine, garlic, and ginseng can also cause bleeding.

• Since all blood thinners except aspirin need to be stopped, it is beneficial to consult your doctor.

 

How is an intercostal nerve block administered, and how long does it take?

The intercostal nerve block is applied in the operating room environment, under local anesthesia. During this time, blood pressure, heartbeat, and respiration are continuously monitored by an anesthesiologist. The patient is laid face down, the area is sterilized, and necessary preparations are completed. Sedation, which is a superficial anesthesia, is applied so that the patient does not feel pain. This ensures that the patient neither feels pain nor remembers the procedure. The rib to which the intervention will be applied is identified under imaging. The nerves of that rib pass just below it. Under imaging, the needle is directed to the edge of the rib. Contact with the rib is established. As soon as contact is made, the needle is slightly retracted and advanced 1-2 mm towards the bottom of the rib. A dye is injected to confirm the location of the rib nerve. Then, a local anesthetic and steroid solution, or a destructive medication like phenol, is administered to the rib nerve. The procedure is completed within 5-10 minutes.

 

Is an intercostal nerve block painful?

If an intercostal nerve block is applied under sedation, it is not painful. Otherwise, the patient may feel pain during the application. However, this pain is very brief.

What should I expect from an intercostal nerve block?

If the intercostal nerve block is applied correctly, it is very successful. Often, a single application is sufficient. As the fracture heals, the nerve returns to its place.

When can I start work after an intercostal nerve block?

After an intercostal nerve block, the patient can start work immediately.

What are the risks and side effects?

Great care must be taken when applying an intercostal nerve block. Otherwise, if the needle is advanced too much, it can head towards the lung and cause pneumothorax, a condition where the aeration of the lung is disturbed. Therefore, it must be applied by individuals specialized in this area.

Who should not receive an intercostal nerve block?

It should not be applied if there is an infection in the skin or subcutaneous tissue around the ribs that are fractured or have metastases.