Image-Guided Interventions for Intercostal Neuralgia: What the Radiologist Needs to Know

Nerve blocks are excellent adjuncts to multimodal systemic analgesia in patients needing complex pain management, often producing days, weeks, or months of pain-free periods. Pain often debilitates patients with significant disruption to quality of life. Intercostal nerve injection and ablations are very useful procedures in patients suffering from pain caused by trauma, tumour, or inflammation. Traditionally done using anatomical landmarks, these procedures have been associated with a higher rate of complications. When imaging modalities (such as ultrasonography or computed tomography (CT)) are used for guidance, complications are significantly reduced, ensuring better outcomes in these vulnerable patients. A variety of other regional techniques can also be used as alternatives to intercostal nerve block such as epidural, paravertebral, erector spinae plane blocks, anterolateral and anteromedial chest wall plane blocks. Interventions for intercostal neuralgia are relatively easy to perform under imaging guidance, with reliable results and fewer complications.