Drug blockade of the cervical vertebrae of the sympathetic trunk along with the vagus nerve is called "vagosympathetic blockade". It was prescribed by Alexander Alexandrovich Vishnevsky with the intention of interrupting nerve impulses during pleuropulmonary shock due to traumatic disorders and injuries of the chest area.
Gives a stable positive result in inflammatory diseases and various muscle tone ailments.
Cervical novocaine blockade was tested by S. G. Zograbyan in order to recognize the hypotension syndrome of traumatic origin. Observations were made on experimental brain injury, in which the blockade of the cervical sympathetic nodes in animals with cerebral hypotension can lead to an increase in intracranial pressure for a short time. Headache is reduced in 80% of cases after this procedure. But the result lasted only a couple of hours. This is due to the fact that the blockade temporarily relieves spasm of the brain vessels, as a result, the blood supply to the brain improves.
What is the procedure based on?
Vagosympathetic blockade is a method of non-standard pathogenetic treatment based on:
- In a momentary stop of peripheral nerve patency.
- On the reaction of an unenriched novocaine solution to the signaling functions of the central nervous system (CNS).
Benefits of blockade
According to these provisions, A. Vishnevsky came to some conclusions:
- For various reasons, the process of inflammation at the beginning of its growth is subject to the same patterns.
- The growth of the inflammation process can be stopped while it is at the stage of serous tissue impregnation.
- A severe form of inflammation is very quickly limited, suppurating and resolved, and a weakly passing one is detected.
- Infiltrative, non-acute and other chronic forms of inflammation are expressed by trophic shifts, sometimes quickly resolved.
- Diseases associated with pathological changes in the functioning of organs. A slight irritation of the nervous system, which is carried out by the cervical vagosympathetic blockade, removes the organ from the altered state. At the same time, the blockade in such processes has a multifunctional effect: it resolves spasm, restores work during paresis.
- Processes of a pathological nature, which are caused by a change in the work and passage of capillaries, novocaine blockade directs to correct the physiological position of the vascular wall.
What types of blockades exist?
Let's consider this issue in more detail. Main types of blockades:
- Blockade of the fracture site of long tubular bones.
- Case shoulder blockade.
- Case blockade of the lower leg.
- Cross section blockades.
- Femoral nerve block
- Sciatic nerve.
- Tibial nerve.
- Peroneal nerve.
- Intercostal conduction block.
- Paravertebral blockade.
- And of course, the cervical vagosympathetic.
Vagosympathetic blockade: indications
Indications for cervical vagosympathetic blockade are also:
- Pleuropulmonary shock.
- Multiple broken ribs.
- Open, closed and valvular clusters.
- Respiratory tract burns.
- Postoperative pneumonia.
- Traumatic strangulation syndromes.
- Fat blockage syndromes (pulmonary form).
Most often, it is precisely when these pathologies occur that the procedure is performed.
In order for the vagosympathetic blockade to be carried out according to the Vishnevsky method, it is necessary to know the clumsy-anatomical connections of the sympathetic trunk and the vagus nerve. These neoplasms are located above the hyoid bone, in one cellular area, which explains the likelihood of synchronous blocking when novocaine is injected here. They are separated below by the parietal layer of the fourth fascia.
Patient preparation
Before the start of the blockade, the doctor examines the inscription on the bottle or ampoule with anesthetic. The patient must be in a supine position, because due to the action of anesthesia, the appearance of various complications is not excluded. Before surgery, always treat the skin with an antiseptic solution. Blockade also requires this. Processing must be carried out without fail, since pathogens cannot be allowed to enter the puncture site.
After that, the area of the skin must be covered with sterile underwear.
What happens next?
The patient is laid on his back, while a roller is placed under the shoulder blades. The head is turned to the other side of the blockade. The patient's hand is pulled down from the side of the blockade. On the posterior border of the right sternocleidomastoid muscle, about 1-1.5 cm above its center, 1-2 ml of 0.25-5% anesthetic solution is injected under the skin. If the outline of the jugular vein is not visible, then the place of insertion of the needle is predetermined by the level of the upper edge of the thyroid epiglottis.
How exactly does vagosympathetic blockade work?
The technique is unique, it is carried out only by highly qualified specialists. With the index finger of the free hand, the muscles and vessels are displaced inward and the initial surface of the cervical vertebrae is probed. Next, a large needle is inserted at the end of the finger and moved inward, towards the initial surface of the vertebrae. In the process of introducing a needle with a small volume, 2-3 ml each, an anesthetic solution is additionally injected to anesthetize the procedure. Afterafter the end of the needle has touched the vertebrae, an aspiration test is done (performed in order to avoid intravascular injection of an anesthetic). After making sure that blood is not drawn into the syringe, 30-60 ml of 0.25% anesthetic solution is slowly injected. Then the needle is pulled out, and the injection site is pressed with a sterilization gauze swab for 1-2 minutes.
If you strictly observe and follow the rules for conducting a vagosympathetic blockade, the anesthetic solution fixes the vagus nerve and other nerves that extend from the cervical nodes of the sympathetic trunk.
Symptoms after the procedure
Effectively performed vagosympathetic blockade in a patient causes the following symptoms:
- Ptosis (drooping of the upper eyelid).
- Miosis (pupil constriction).
- Enophthalmos (recession of the eyeballs inward; Horner's triad).
- Redness of the face and mucous membranes of the eyes.
- Pericorneal vascular injection.
- Decrease in sweating from the blockade.
Cervical vagosympathetic blockade according to Vishnevsky suppresses pain, cough reflex, tones the circulatory system and increases blood pressure.
The blockade cannot be done from both sides at once. The time interval between procedures should be at least 30-40 minutes. Also, during the procedure, adrenaline should not be added to the anesthetic solution.
What caused such restrictions? The point is that you can accidentally achieverespiratory paralysis due to blockage.
Complications
After the procedure, complications may also arise:
- Violation of the carotid artery during piercing.
- Violation of the internal jugular vein.
- Esophagus disorder.
The likelihood of developing atony and intestinal paresis (such complications do not need special treatment).
All this can be provoked by cervical vagosympathetic blockade according to Vishnevsky. We reviewed her testimony.
Alternative
Another intervention on parts of the neck requires access, that is, the dissection of each layer of the skin. To access the neck, it is necessary to maintain hygiene, as this is an open part of the body. Because of this, a transverse Kocher access is used on the neck, running along the transverse folds of the skin. Stitches after surgery in this case are usually invisible. When performing surgery on parts of the neck with a longitudinal arrangement, a longitudinal incision is often used along the anterior or posterior edge of the sternocleidomastoid muscle. Seams are especially noticeable after the median longitudinal incision. Vagosympathetic blockade (the technique is quite common) will help to avoid this operation.
You should not joke with your he alth, you should follow safety precautions and not lose vigilance. Then various unpleasant accidents can be avoided.
