Intercostal Nerve Block

Alan Poon, M.D.
House Officer

Pankaj Guglani, M.D.
Lecturer

Department of Anesthesiology
University of Michigan Health System
Ann Arbor, MI

Introduction - TOP

The intercostal nerves, numbering twelve bilaterally, supply sensory innervation to the skin and musculature of the anterolateral chest and abdominal walls.  Proximal blockade of these nerves using local anesthetics is among the oldest of peripheral nerve blocks, having been described as early as 1907.1  It was borne out of efforts to improve surgical anesthesia of the chest and abdomen, which at that time was accomplished by a “field block” of peripheral nerve endings using large, dilute volumes of local anesthetic.2  As time passed, the idea of blocking the intercostal nerves at their origins has gained increasing favor. By 1922, a detailed account of intercostal nerve blocks was recorded that is much the same as today’s approach.3

While the popularity of intercostal nerve blocks has historically been limited by the potential risk of pneumothorax (see discussion under “Complications”), this block continues to enjoy a versatile role within the repertoire of the anesthesiologist.  The technique of this block is relatively straightforward and may be performed unilaterally or bilaterally, at single or multiple levels, with a rapid onset of effect.  As such, it can be tailored to a wide variety of surgical procedures and painful conditions.2,4,5,6

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