Typically, intercostal blockade may be performed with a trajectory view angled superiorly toward the inferior aspect of the intended costal margin, followed by the anteroposterior (AP) and lateral fluoroscopic views. The location is usually between 3 inches lateral to the spine and the posterior axillary line, but the injection may be performed at any area proximal to the site of pain. At the insertion point, the needle is “walked off” of the inferior border of the rib with an effort to maintain an inferior-to-superior needle trajectory until the needle “steps off” of the rib margin. The depth should be no more than 2 to 3 mm past the rib margin to avoid a potential pneumothorax. The pleura lie in close proximity to the ribs, and the risk for pneumothorax is significant if the needle is advanced too far ventrally.

Considering the layout of this book, images of the trajectory, AP, and lateral views are provided. Although these views may not be all necessary to obtain a successful intercostal nerve block, they may yield an additional margin of safety. Consider a hybrid US procedure ( Chapter 23B ) to visualize the pleura for additional safety.