Intercostal nerve block

Intercostal nerve block may be performed using an anatomic approach (at site B) by palpating the rib. Alternatively, ultrasound guidance may be used to inject local anesthetic more proximal in the course of the nerve (at site A), since palpation of the rib is less important. With either approach, the needle is inserted at the inferior border of the rib, and after negative aspiration, 3 to 5 mL of LA (0.2% ropivacaine or 0.25% bupivacaine with epinephrine 1:200,000) is injected. For details of intercostal nerve block, refer to related UpToDate content.