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51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting
April 16 - 18, 2026 | Phoenix, Arizona
2314249
Long-Acting Proximal Intercostal Nerve Block for the Management of Intercostal Neuralgia in the Third Trimester of Pregnancy
Poster Presenter
Authors
Bridget Marcinkowski, Mariana Restrepo-Holguin, Alexander Stone
Affiliations
Part of Topic
Medically Challenging Cases
Long-Acting Proximal Intercostal Nerve Block for the Management of Intercostal Neuralgia in the Third Trimester of Pregnancy
Bridget Marcinkowski, MD1; Mariana Restrepo-Holguin, MD1; Alexander Stone, MD1
1 Department of Anesthesiology, Brigham and Women’s Hospital, Boston, MA
Introduction:
•Intercostal neuralgia can cause neuropathic thoracic pain in pregnancy
•Many analgesics, including those most effective for neuropathic pain, are rated Class C or D in pregnancy
Case Report:
•32F @ 35wk GA with unilateral lower mid-axillary rib pain x7d > non-pharmacologic interventions, acetaminophen, & oxycodone were minimally effective
•Single shot proximal intercostal nerve block (PICB) was performed with 25 mL of 0.25% bupivacaine + 4 mg of dexamethasone
•Pain completely resolved & patient was discharged
Discussion:
•PICBs may reduce opioid exposure, prevent unnecessary hospitalization, & improve patient comfort while limiting fetal exposure to systemic analgesics