Intercostal Nerve Radiofrequency
Where are the intercostal nerves?The intercostal nerve are part of the somatic nervous system and arise from the T1 to T11 levels of the spinal cord. A separate intercostal nerve, artery and vein lies underneath each rib.
When is an intercostal nerve block performed?When the intercostal nerve is damaged, a localized shooting pain may be felt across the chest. Injury to the intercostal nerve can occur due to blunt or penetrating injuries to the chest, rib fractures, cardiothoracic surgery, radiotherapy, herpes zoster (shingles). A nerve block to the affected intercostal nerve may provide relief of pain. A pulsed radiofrequency ablation can be performed at the same time to prolong the period of pain relief.
When is an intercostal nerve block performed?When the intercostal nerve is damaged, a localized shooting pain may be felt across the chest. Injury to the intercostal nerve can occur due to blunt or penetrating injuries to the chest, rib fractures, cardiothoracic surgery, radiotherapy, herpes zoster (shingles). A nerve block to the affected intercostal nerve may provide relief of pain. A pulsed radiofrequency ablation can be performed at the same time to prolong the period of pain relief.
Before the procedureYou will need to fast before the procedure. This means: - No food 6 hours before - No liquids (except water) 6 hours before. This includes coffee, tea, orange juice etc.- You can drink water up to 2 hours before the procedure.
Take your usual medications with a small sip of water.Please contact us if you are taking any blood thinning medications, diabetes medication, pregnant, or unwell.
The procedureThe procedure itself takes 20-30 minutes. It is a day case, meaning no overnight stay is required. An Anaesthetist will provide sedation and monitor you during the procedure. The procedure is performed in the operating room with fluoroscopy (X-ray) to ensure accurate needle placement. Specialized equipment including the radiofrequency needle, probe and radiofrequency machine is used to heat the needle to a temperature of 42 degrees. The nerve is pulsed with radiofrequency waves and local anaesthetic with steroid is injected following the nerve ablation. The local anaesthetic provides immediate pain relief, whereas the pulsed radiofrequency and steroid may take several weeks to provide sustained pain relief. Pain relief usually lasts between 6-12 months. The procedure can be repeated if your pain returns.
After the procedure You will be taken to recovery and monitored until you are ready for discharge. You will not be able to drive, so ensure someone can drive you home safely. Avoid over-exerting yourself immediately after the procedure. You may gradually return to your day-to-day activities. If you develop any symptoms (fever, swelling, worsening weakness or numbness, bleeding) after the procedure or have any other concerns, please contact us, your GP, or your local Emergency Department.
You will be reviewed by our pain nurse via telephone a few days after the procedure. What are the risks? No procedure is risk-free but the risks for this procedure are considered to be relatively low. Possible risks include infection, bruising, haematoma, nerve injury and allergic reactions. Infection is minimized with appropriate sterile and aseptic precautions. Bleeding risk is minimized by stopping blood-thinning medications a few days prior. If this applies to you, our pain nurse will remind you to stop your blood-thinning medications a few days prior to your procedure. Risk of nerve injury is minimized as we use fluoroscopy to guide accurate needle placement. There is a very small risk of a pneumothorax which can either be conservatively managed or may require a chest drain. Severe allergic reactions to the injectates (ie local anaesthetic, steroids) are very uncommon. Steroids may produce side effects including stomach irritation, insomnia, mood swings, flushing, palpitations. Post-procedural flare is common after a rhizotomy and can be treated with painkillers. Neurological complications including weakness, paraesthesia, numbness have been described but are extremely rare. Radiofrequency treatment can produce patchy numbness on the overlying skin.
Patients need to be aware that the outcome of the procedure is variable between individuals and they may not receive the desired benefits. The therapeutic benefits of the procedure are transient, and repeat injections may be required.
Take your usual medications with a small sip of water.Please contact us if you are taking any blood thinning medications, diabetes medication, pregnant, or unwell.
The procedureThe procedure itself takes 20-30 minutes. It is a day case, meaning no overnight stay is required. An Anaesthetist will provide sedation and monitor you during the procedure. The procedure is performed in the operating room with fluoroscopy (X-ray) to ensure accurate needle placement. Specialized equipment including the radiofrequency needle, probe and radiofrequency machine is used to heat the needle to a temperature of 42 degrees. The nerve is pulsed with radiofrequency waves and local anaesthetic with steroid is injected following the nerve ablation. The local anaesthetic provides immediate pain relief, whereas the pulsed radiofrequency and steroid may take several weeks to provide sustained pain relief. Pain relief usually lasts between 6-12 months. The procedure can be repeated if your pain returns.
After the procedure You will be taken to recovery and monitored until you are ready for discharge. You will not be able to drive, so ensure someone can drive you home safely. Avoid over-exerting yourself immediately after the procedure. You may gradually return to your day-to-day activities. If you develop any symptoms (fever, swelling, worsening weakness or numbness, bleeding) after the procedure or have any other concerns, please contact us, your GP, or your local Emergency Department.
You will be reviewed by our pain nurse via telephone a few days after the procedure. What are the risks? No procedure is risk-free but the risks for this procedure are considered to be relatively low. Possible risks include infection, bruising, haematoma, nerve injury and allergic reactions. Infection is minimized with appropriate sterile and aseptic precautions. Bleeding risk is minimized by stopping blood-thinning medications a few days prior. If this applies to you, our pain nurse will remind you to stop your blood-thinning medications a few days prior to your procedure. Risk of nerve injury is minimized as we use fluoroscopy to guide accurate needle placement. There is a very small risk of a pneumothorax which can either be conservatively managed or may require a chest drain. Severe allergic reactions to the injectates (ie local anaesthetic, steroids) are very uncommon. Steroids may produce side effects including stomach irritation, insomnia, mood swings, flushing, palpitations. Post-procedural flare is common after a rhizotomy and can be treated with painkillers. Neurological complications including weakness, paraesthesia, numbness have been described but are extremely rare. Radiofrequency treatment can produce patchy numbness on the overlying skin.
Patients need to be aware that the outcome of the procedure is variable between individuals and they may not receive the desired benefits. The therapeutic benefits of the procedure are transient, and repeat injections may be required.
DisclaimerThe above information is for general education only and is not intended as a substitute for your own independant health advice. At Western Pain clinic we comprehensively assess each patients pain condition and provide advice using the latest evidence-based treatments. If you would like to find out more information about intercostal nerve block and rhizotomy, please discuss this with our doctor during your consultation.