Intercostal Blockade

Chapter 26 Intercostal Blockade



Jonathan B. Stone, Michael A. Klein, Michael B. Furman


An intercostal nerve block can be helpful for the treatment of painful intercostal neuropathy, herpes zoster, and rib fractures. It may also be useful for the diagnosis and treatment of uncommon abdominal or chest wall pain.1


Typically, this block may be performed with just one anteroposterior (AP) fluoroscopic view with a trajectory view angled superiorly toward the inferior aspect of the intended costal margin. The location is usually between 3 inches lateral to the spine and the posterior axillary line, but the injection may be performed at any area proximal to the site of pain. At the insertion point, the needle is “walked off” of the inferior border of the rib with an effort to maintain an inferior-to-superior needle trajectory until the needle “steps off” of the rib margin. The depth should be no more than 2 to 3 mm past the rib margin to avoid a potential pneumothorax. The pleura lies in close proximity to the ribs, and the risk for pneumothorax is significant if the needle is advanced too far ventrally.


The absorption rate of local anesthetics is greater in the intercostal area because of the close proximity to vascular structures.2 Given this, one should be mindful of the concentration and volume of local anesthetic used for this procedure.


As with any procedure, careful patient selection is important. Patients with compromised pulmonary function (e.g., those with severe chronic obstructive pulmonary disease) may be poor candidates for this procedure because of the associated risk for pneumothorax and its resultant further respiratory compromise. Bilateral intercostal nerve blocks would not be recommended on the same day because of the attendant risk of pneumothorax and its potential complications.


In keeping with the layout of this book, images of the trajectory, AP, and lateral views are provided. Although these views may not be all necessary to obtain a successful intercostal nerve block, they may yield an additional margin of safety.


Note: Please see page ii for a list of anatomical terms/abbreviations used in this book.



image Trajectory View (Figure 26–1)



image image image

Figure 26–1 A, Fluoroscopic image of a trajectory view of a T9 intercostal nerve block with the needle in position at the inferior border of the ninth rib. B, Radiopaque structures, trajectory view. C,

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Dec 23, 2015 | Posted by in INTERVENTIONAL RADIOLOGY | Comments Off on Intercostal Blockade

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