Intercostal Nerve Block

Most people feel a pinch and brief stinging as the skin is numbed, then pressure as each injection is given^[9]. Because the needle is guided to the lower edge of each rib, you may feel a short ache along the rib. Light sedation is available if you are anxious. Afterward, soreness or bruising at the injection sites usually clears within a couple of days^[9].

The injections themselves usually take 15 to 30 minutes, depending on how many ribs are treated. Plan to be with us longer: after the block you rest for 15 to 30 minutes while a nurse checks on you^[9], and check-in and preparation add time. If you receive sedation, you will stay a little longer and need a ride home.

Good candidates have band-like burning, stabbing or aching pain along one or more ribs from intercostal neuralgia, shingles, a rib injury or chest surgery, and the pain has not improved enough with medicines^[2][9]. Heart, lung and abdominal causes of the pain should be ruled out first. People with severe lung disease need a careful discussion because of the small risk of a collapsed lung.

Your chest wall may feel numb for several hours, and your usual pain may return as the anesthetic wears off. If a steroid was used, longer relief usually begins in two to three days^[9]. Mild soreness is common. Watch for shortness of breath or sharp chest pain when breathing in — possible signs of a collapsed lung — and call us or seek urgent care right away if they occur.

For the rest of the day, avoid strenuous exercise, heavy lifting, swimming and hot tubs, and do not drive if you were sedated. Do not apply heat to a numb area, since you may not feel a burn. Keep the injection sites clean and dry until the next day. Most people return to normal activities the following day. Call us for fever, redness or pus at the site, or new weakness or tingling^[9].

If you had no sedation and feel well, you may be able to drive, but we recommend bringing a driver, especially for your first block. If you receive any sedation, someone else must drive you home and you should not drive for the rest of the day^[9].

It varies. The numbing medicine lasts hours; with a steroid, relief often begins in two to three days and, for some people, lasts several months^[9]. Some people get little or no benefit and need a different treatment^[9]. A short-lived response still has value, because it confirms that the intercostal nerve is carrying the pain.

The most common effects are soreness or bruising. The main specific risk is a pneumothorax (collapsed lung); in one study of rib-fracture patients it occurred after 1.4% of individual nerves blocked^[5]. Most small ones need only observation^[1]. Other rare risks include bleeding, infection, nerve damage and local anesthetic toxicity^[9][1].

It depends on your plan and why the block is done. Medicare’s local policy for New York, effective October 25, 2026, lists intercostal nerve blocks for chronic pain as non-covered; the policy does not address blocks for acute pain^[7]. Commercial plans vary and often need prior authorization, and New York workers’ compensation and no-fault claims follow their own rules. Our staff will check your benefits and explain your options before scheduling.

Not always. Tell us about every blood thinner and supplement you take. Interventional pain guidelines rate each procedure’s bleeding risk, and your physician uses that rating and your medical history to decide whether any medicine should be paused^[8]. Never stop a blood thinner without talking to the doctor who prescribes it^[9]; we will coordinate with them.

Yes. If a block clearly helps, periodic repeat injections may be an option^[9]. We space steroid injections apart to limit side effects and look for better function, not just lower pain scores. Medicare does not consider regularly scheduled repeat nerve injections a long-term solution^[7], so if you need blocks often, we will discuss longer-lasting options.

Nerve-pain medicines, topical treatments and physical therapy remain the foundation. If blocks help only briefly, your physician may discuss peripheral nerve stimulation, Scrambler therapy or, in selected cases, spinal cord stimulation. Radiofrequency ablation and cryoneurolysis of the intercostal nerves are also used, although the evidence for them is very limited^[7].