High Chemical Company
3901 Nebraska Ave, Suite A
Levittown, PA 19056

(800) 447-8792


Injection Techniques

Intercostal Nerves

The intercostal nerves are the anterior divisions of the thoracic paravertebral nerve (T1 to T12). The intercostals supply sensory processes for the thoracic pleura and abdominal peritoneum. each intercostal nerve runs its own independent course without plexus formation. A branch from the twelfth nerve, also call the subcostal nerve, joints the first lumbar nerve to contribute to the lumbar plexus.


Points of injection are determined by interpreting peripheral areas of pain and tenderness, paravertebral tenderness and the landmarks of the spine.

Injection Technique

Once the patient is in the lateral position, identify the rib Paravertebral Nerve Block of the affected intercostal nerve.

1. Mark the lower margin of each affected rib.
2. Carefully advance a 1½-inch, 25-gauge needle at the marked point until the needle tip impinges upon the periosteum of the underlying rib.
3. Withdraw the needle back into the subcutaneous tissues and “walk” it inferiorly off the inferior rib margin.
a. Be sure not to advance the needle any farther than just beyond the inferior rib margin.
b. Advancing the needle farther may result in damage to the abdominal viscera.
4. Aspirate to ensure that the needle has not invaded an artery or a vein, and gently inject solution.
a. While limited resistance to the injection is normal, withdraw needle slightly and proceed if there is significant resistance.