Ultrasound-guided Intercostal Nerve Block in Chronic Musculoskeletal Chest Pain: A Case Report

Abstract

Introduction: Chronic musculoskeletal chest pain, though not life-threatening, is a disabling condition and is often left untreated or improperly managed. Case description: A 45-year-old male presented with pain in the lower part of the left lateral chest wall (visual analog scale (VAS) for pain = 6) for the last 4 months aggravating with deep inspiration (VAS = 7). On examination, there was grade III tenderness over anterior end of the 10th rib but no swelling. Examination of both upper limbs (including shoulder joints), spine, and abdomen was unremarkable. Cardiac and respiratory systems were within normal limits. We investigated the patient to exclude various differential diagnoses. Ultrasound evaluation of the 10th rib at the most tender point was suggestive of costochondritis. Three weeks of conservative management yielded inadequate relief (VAS = 6, both at rest and deep inspiration). As a case of recalcitrant costochondritis, ultrasound-guided intercostal nerve block was performed for the left 9th and 10th intercostal nerves. The patient achieved immediate reduction in pain at rest (VAS = 2) and deep inspiration (VAS = 3). At 2 weeks of follow-up, pain reduced further (VAS = 1) both at rest and deep inspiration. At 4 weeks of follow-up, pain reduced completely (VAS = 0) both at rest and deep inspiration. Conclusion:The ultrasound-guided intercostal nerve block is a relatively simple day-care procedure that can prove effective in a properly selected patient. Despite perceived simplicity of the procedure, there are risks involved that should be carefully considered while planning and performing the procedure.