Destruction by neurolytic agent, intercostal nerve
CPT4 code
Name of the Procedure:
Destruction by Neurolytic Agent, Intercostal Nerve
Common Names: Intercostal Nerve Block, Neurolytic Intercostal Nerve Block
Summary
A procedure in which a chemical agent is injected to destroy part of the intercostal nerve, providing relief from chronic pain in the chest and upper abdomen. The procedure is minimally invasive and primarily used for patients who suffer from persistent pain not relieved by other treatments.
Purpose
The procedure targets chronic, severe pain usually caused by rib fractures, herpes zoster (shingles), post-thoracotomy pain, and certain types of chest wall tumors. The goal is to provide long-lasting pain relief and improve quality of life.
Indications
- Severe, chronic pain in the chest or upper abdomen area
- Pain unresponsive to conventional treatments such as medications or physical therapy
- Conditions like rib fractures, post-herpetic neuralgia, or post-surgical pain
- Patients needing a less invasive pain management option
Preparation
- Patients may be advised to fast for a few hours before the procedure
- Adjustments to current medications, especially blood thinners, may be required
- Pre-procedure diagnostic tests, such as imaging (CT scan or MRI) and blood tests
- Inform your healthcare provider about any allergies or existing health conditions
Procedure Description
- The patient is positioned to allow access to the affected intercostal nerve area.
- Local anesthesia or mild sedation may be administered for comfort.
- Using imaging guidance (like fluoroscopy or ultrasound), a needle is inserted close to the intercostal nerve.
- A small amount of neurolytic agent (such as alcohol or phenol) is injected to destroy the nerve.
- The needle is carefully withdrawn, and a dressing is applied to the injection site.
Duration
The procedure typically takes about 30 minutes to an hour to complete.
Setting
The procedure is usually performed in a hospital, outpatient clinic, or surgical center equipped with necessary imaging technology.
Personnel
- Interventional Pain Specialist or Anesthesiologist
- Nurses to assist with the procedure and patient monitoring
- Radiologic Technologist for imaging support
Risks and Complications
- Common: temporary pain at the injection site, bruising, weakness in the chest wall muscles
- Rare: nerve damage, infection, allergic reaction to the neurolytic agent, pneumothorax (collapsed lung)
- Complications are managed by the healthcare team and might require additional treatment
Benefits
- Significant and prolonged pain relief
- Improved mobility and quality of life
- Reduction in the need for oral pain medications
Recovery
- Patients are usually monitored for a short period post-procedure before discharge
- Mild soreness or discomfort at the injection site might be experienced and can be managed with over-the-counter pain relievers
- Most patients can return to normal activities within a day or two
- Follow-up appointments may be scheduled to assess pain relief and monitor for any complications
Alternatives
- Oral or topical pain medications
- Physical therapy
- Transcutaneous Electrical Nerve Stimulation (TENS)
- Surgical interventions like rib resections, depending on the underlying condition
- Each alternative has its pros and cons which should be discussed with your healthcare provider
Patient Experience
- During the procedure, most patients feel minimal discomfort due to local anesthesia
- Sedation may lead to grogginess post-procedure, which typically resolves quickly
- Pain relief may be noticeable within a few days to a week
- Pain management plans, including medications and supportive care, will be discussed to ensure patient comfort