Ultrasound-guided intercostal block for the management of intercostal neuralgia in pregnant women: Case series and review of the literature.

Abstract

Intercostal neuralgia (ICN) in pregnancy is a rare condition which, to date, has not been well studied. Due to the lack of evidence, there is not a consensus about effective therapeutic strategies for this condition. The present study investigated the feasibility of ultrasound-guided intercostal block (UG-ICB) using ropivacaine for these patients. A total of 17 cases treated at the University Hospital Bonn from May 2017 to September 2024 were reviewed. Patients presenting with severe unilateral chest or flank pain were diagnosed with ICN. UG-ICB was applied, and all patients reported immediate pain relief, with only two women requiring a second infiltration due to pain recurrence. No serious adverse events were recorded. The application technique can be consulted in the video related to this publication. The present study highlights that UG-ICB is feasible, safe and appears to be effective for managing ICN during pregnancy. This procedure provides significant pain relief while minimizing risks to the fetus. Reviewing the literature this study group was unable to find qualitative evidence assessing ICN and rib pain in pregnancy, although this condition is thought to be related to pregnancy. Further research is recommended to improve treatment strategies for ICN during pregnancy and bridge the gap between clinical knowledge and evidence surrounding this condition.