Pain Management Procedures
Intercostal Nerve Block and Radiofrequency Ablation
Intercostal Nerve Block and Radiofrequency Ablation
What are these procedures?
Intercostal nerves run beneath each rib and carry sensation from bands of the chest and upper abdominal wall. A nerve block places local anesthetic, sometimes with steroid, near one or more intercostal nerves. RFA may be considered after a clearly helpful diagnostic block when longer relief is needed.
When may they be recommended?
Possible reasons include persistent rib or chest-wall pain after injury or surgery, intercostal neuralgia, and selected cases of postherpetic neuralgia. Before a pain procedure, new chest pain must be evaluated for heart, lung, vascular, or other urgent causes.
What happens?
You sit, lie on your side, or lie face down. Ultrasound or fluoroscopy identifies the rib, nerve region, blood vessels, and pleura covering the lung. A thin needle is placed near the nerve and medication is injected. RFA uses a specialized needle and controlled energy to interrupt pain signaling.
What should I expect?
A band of the chest wall may feel numb. Because each intercostal nerve supplies a limited strip, more than one level may need treatment. Relief from a block can be temporary; RFA relief often develops over days to weeks and may last months.
Important risks
In addition to bleeding, infection, medication reaction, and nerve injury, intercostal procedures carry a specific risk of pneumothorax, or collapsed lung. Seek urgent care for new shortness of breath, sharp chest pain, rapid heartbeat, or faintness after the procedure.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.