Tony Romo, the star quarterback of the Dallas Cowboys of the NFL sustained a fractured rib and punctured lung in last weekend’s game against the San Francisco Giants. On the way to work today on ESPN sports radio I heard a discussion about a “shot” that Romo might get to allow him to play with less pain this weekend. There was discussion as to whether a “pain shot” might be something that a quarterback, who presumably needs to play at a higher cognitive level than say the ex-defensive lineman who brought up the subject might need to have to play effectively.
This prompted me to write about what type of shot they are discussing. The injection likely being considered for Romo is a type of regional anesthesia known as a nerve block. This type of injection is commonly used in areas where a nerve that gives sensation to an area of the body can safely have an injection of local anesthetic placed near the nerve proximal to an area where pain is experienced or expected to be experienced. Dental anesthesia is an example of a nerve block that many people can relate to personally. A broken rib is this type of situation.
The nerve that supplies the rib runs just under the lower margin to the rib, and runs from back to front. This means that if a local anesthetic is injected near the lower border of a rib well behind (posterior to) the area of the fracture this area will become numb. The local anesthetic is safely injected just above the rib below the one that is cracked to avoid injury from injection directly into the nerve or blood vessels, and so that it can diffuse through the tissues up to the nerve just above that area, i.e. the lower margin of the rib above where the never is located.
If Mr. Romo has only one rib that is cracked this type of nerve block, called an intercostal nerve block, could potentially give him excellent anesthesia without interfering with his performance cognitively. It could also be done relatively safely, as minor movements of the cracked rib though extremely painful are not terribly dangerous. I expect Romo to have just this type of intercostal nerve block and play effectively against the Washington Redskins on Monday night. Nothing about an intercostal nerve block is going to interfere with Romo’s play calling, decision making or thought processes. The duration of the nerve block will depend on the type of local anesthetic used, but will likely be a few hours as one of the longer acting agents like Marcaine is usually chosen.
This type of injection is occasionally administered to patients in a physician’s office when they are experiencing severe pain from a cracked rib, and it can be very effective.