Tips for an Intercostal Nerve Block

An intercostal nerve block provides analgesia for rib fractures, postsurgical analgesia for chest and upper abdominal surgery (e.g., thoracotomy, thoracostomy, mastectomy, gastrostomy, and cholecystectomy), herpes zoster, or post-herpetic neuralgia.

Here are the 4 steps we follow to perform an intercostal nerve block

1. Place the transducer lateral to the angle of the rib in a sagittal oblique orientation perpendicular to the direction of two palpable ribs. 
2. Continue by scanning the intercostal space laterally between the costal angle and posterior axillary line where the neurovascular bundle has not yet divided. 
3. Insert the needle in-plane or out-of-plane to penetrate the external and internal intercostal muscles. The optimal target needle endpoint is the location just below the internal intercostal muscle to ensure that the needle tip remains superficial to the parietal pleura.
4. Complete the block with 3-5 mL of local anesthetic at each level.

Watch the video below to get a better picture of the process and see how the NYSORA Nerve Blocks App brings these instructions to life:

For more tips like these and the complete guide to the 60 most frequently used nerve blocks, download the Nerve Blocks App HERE. Don’t miss the chance to get the bestselling NYSORA Nerve Blocks App also in book format – the perfect study companion with the Nerve Blocks app!