If you’re living with rib, chest wall or abdominal pain, an intercostal nerve block may be the solution. It’s a targeted injection that pain specialists use to calm irritated or inflamed nerves that run between your ribs and can deliver real relief. They are helpful as a therapeutic intervention or a diagnostic tool.
But what happens after the injection? What kind of pain relief can you expect? And is more than one necessary? Let’s walk through what to expect so you feel confident and prepared heading into your pain management appointment.
What Is an Intercostal Nerve Block for Chest and Rib Pain?
Intercostal nerve blocks (ICNB) are injections that deliver a local anesthetic and sometimes a steroid directly around the intercostal nerves, which run along the underside of each rib. This treatment can be used alone or in conjunction with other therapies to enhance the overall effectiveness of pain relief.[1] The intercostal nerves can become irritated due to surgery, trauma, infections such as shingles, or chronic conditions like intercostal neuralgia. [2] ICNBs may also be used diagnostically to help determine whether pain is visceral (related to internal organs) or somatic (of musculoskeletal origin).[1]
This procedure is commonly used to treat:
- Upper abdominal pain
- Post-thoracotomy pain [2]
- Rib fractures [2]
- Intercostal neuralgia [3]
- Shingles (herpes zoster) pain or postherpetic neuralgia [2]
- Chronic post-surgical abdominal or chest wall pain [4]
How Is an Intercostal Nerve Injection Performed?
The procedure is relatively quick and can often be done in an outpatient setting. Here’s what typically happens:
- You’ll lie on your side or stomach.
- Your skin is cleaned and numbed with a local anesthetic.
- Using ultrasound or X-ray guidance, a fine needle is used to inject the medication near the affected nerve.[5]
You may feel some pressure during the injection, but it should not be significant pain. The entire process typically takes between 15 and 30 minutes.
What Should I Expect After My Intercostal Rib Block?
Preparation for your injection was probably longer than the procedure itself. But what happens after?
Here’s what’s next:
- You’ll rest for about 15 to 30 minutes while the medication takes effect. [2]
- You may feel immediate relief thanks to the numbing effects of the local anesthetic.
- Pain may return as the anesthetic wears off because steroids take longer to work.
- It may take a few days before you start noticing relief from the steroid portion of the injection. You may feel relief for weeks or even months.[6]
It’s normal to feel a little sore at the injection site for a day or two. Applying ice and taking it easy can help alleviate the pain.[7] ICNBs are a relatively safe procedure with minimal risk of complications, but side effects are possible. If you experience new or worsening chest pain, shortness of breath, or signs of infection (such as fever or redness), contact your healthcare provider immediately.[2]
Can I Go Home After My Intercostal Block Procedure?
Yes, you can go home after your observation period as long as your doctor is satisfied with your pulse, blood pressure, and overall condition. Before you leave, you’ll be asked to rate your pain level and provided with instructions for at-home care.
Just a heads-up: you will need someone to drive you home, and it’s a good idea for them to stay afterward in case you need assistance with anything.
It’s also normal to have some soreness or mild bruising at the injection site over the next few days. Applying a cold compress several times a day can help ease that discomfort.
Be sure to avoid driving, operating heavy equipment, or engaging in strenuous activity for at least the remainder of the day while the medication takes effect.[7]
Will I Need More Than One ICNB?
That depends. Some patients only need one injection to “reset” their pain cycle. Others may require a series of blocks to maintain long-term relief, especially in cases of chronic nerve pain or intercostal neuralgia.[8]
If the blocks work well but don’t last long, your pain specialist may discuss additional injections or more permanent options with you.
Intercostal Nerve Blocks and Beyond: Building a Comprehensive Pain Management Plan
An intercostal nerve block can be a powerful tool in reducing chest or abdominal pain. Still, you’ll get the most out of your treatment when it’s part of a comprehensive, multidisciplinary pain management plan. Your pain specialist may combine your injection with other interventions like radiofrequency ablation (RFA) or peripheral nerve stimulation (PNS) for longer-lasting relief. Complementary therapies such as acupuncture, physical therapy, or even mindfulness-based stress reduction can help round out your treatment by addressing the physical and emotional components of chronic pain.
The best pain management plans also incorporate lifestyle changes, such as gentle exercise, stress management, sleep support, and a balanced diet. Because pain isn’t just a nerve problem, it’s a whole-body experience. Your pain management specialist will consider the whole picture and work with you to develop a personalized plan tailored to your specific pain. Together, these added layers of care can help you feel your best, function more effectively, and navigate life with confidence.
Resources:
- Baxter CS, Singh A, Ajib FA, et al. Intercostal Nerve Block. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (Accessed July 15, 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482273 /
- Intercostal Nerve Block. Cleveland Clinic [Internet]. Accessed July 15, 2025. Available from: https://my.clevelandclinic.org/health/treatments/17134-intercostal-nerve-block
- Pietrangelo A. Intercostal Neuralgia. Healthline [Internet]. Accessed July 15, 2025. Available from: https://www.healthline.com/health/intercostal-neuralgia
- Peripheral Nerve Injections: Intercostal nerve block for the Treatment of Pain. Faculty of Pain Medicine of the Royal College of Anesthetists [Internet]. Accessed July 15, 2025. Available from: https://fpm.ac.uk/sites/fpm/files/documents/2023-08/Peripheral%20Nerve%20Injections%20-%20Intercostal%20nerve%20block.pdf
- Hao D, Vwaire Orhurhu. Liver Cancer. Elsevier eBooks. Published online January 1, 2021:85-93. doi:https://doi.org/10.1016/b978-0-323-75775-1.00014-3. Accessed July 15, 2025. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/intercostal-nerve-block
- Fazekas D, Doroshenko M, Horn DB. Intercostal Neuralgia. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.Accessed July 15, 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560865/#
- Patient Information on INTERCOSTAL NERVE BLOCK. Kaiser Permanente [Internet]. Accessed July 15, 2025. Available from: https://mydoctor.kaiserpermanente.org/ncal/Images/PI%20Intercostal%20Nerve%20Block%20-%20ADA_tcm75-586107.pdf
- Dunst M, Ferrell B, Grannis, FW, Sullivan E. Continuous extrapleural intercostal nerve block with continuous infusion of lidocaine after thoracotomy: A descriptive pilot study. Johns Hopkins University [Internet]. Accessed July 15, 2025. Available from: https://pure.johnshopkins.edu/en/publications/continuous-extrapleural-intercostal-nerve-block-with-continuous-i
