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Pneumothorax is a rare but potentially serious iatrogenic complication of intercostal nerve block. This case report emphasizes the importance of imaging guidance and careful patient assessment to mitigate complications in high-risk individuals undergoing intercostal nerve block. An elderly male with chronic obstructive pulmonary disease and undergoing chemotherapy for mediastinal metastasis of small-cell liver carcinoma developed severe postherpetic neuralgia resistant to pharmacological therapy. An ultrasound-guided intercostal nerve block was performed which resulted in a pneumothorax, subsequently managed with an intercostal drain. [ABSTRACT FROM AUTHOR]