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Diagnostic Intercostal Block Guiding Definitive Treatment — SCE Palliative Medicine MCQ

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ModerateRespiratory SymptomsDiagnostic Intercostal Block Guiding Definitive TreatmentSCE Palliative Medicine

A 60‑year‑old man with mesothelioma has chronic pleuritic chest pain. He is on morphine MR 60 mg BD and naproxen 500 mg BD with PPI cover. An ultrasound‑guided intercostal nerve block with bupivacaine at T6–T8 provides excellent but temporary (12‑hour) relief. What does this diagnostic block result suggest?

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Correct answer: D — The pain is primarily mediated by intercostal nerves T6–T8; a neurolytic block (phenol or alcohol) or continuous paravertebral infusion could provide longer‑lasting relief

Explanation lettering: E = shown as A · A = shown as C · C = shown as E

Temporary relief from local anaesthetic in the distribution of T6–T8 confirms that intercostal nerves mediate the pain. This diagnostic result supports proceeding to longer‑lasting interventions, such as phenol/alcohol neurolytic block or a continuous paravertebral catheter, consistent with UK palliative care practice. Option A is excluded by the positive response; B is incorrect because visceral pain alone would not respond to a somatic nerve block; C is false—diagnostic blocks guide further treatment; E is unlikely given the congruent temporal and anatomical response.

Reference: Hull University Teaching Hospitals NHS Trust. Intercostal Nerve Block for Pain Relief patient information leaflet (Updated 25 February 2026); Wessex Palliative Care Handbook: temporary intercostal anaesthetic → neurolytic technique (approx 2024). https://www.hey.nhs.uk/patient-leaflet/intercostal-nerve-block-for-pain-relief/