Elimination of radicular lumbar and pain of other localization is considered today one of the most difficult, but at the same time the most important tasks. Observing the regression of the pain syndrome, we can conclude that the chosen therapy is correct. In accordance with modern concepts of vertebrology, acute pain in the lower extremities or spine should be eliminated as soon as possible. With the transition of the state to a chronic course, psychogenic disorders may occur. They, layering on common symptoms, complicate therapy and significantly worsen the prognosis. In this regard, specialists strive to use as short and yet effective methods as possible. One of these is paravertebral blockade. What it is, how it is carried out - more on this later in the article.
General information
Therapeutic blockades are considered the most effective methods of eliminating pain and other manifestations of neurological pathologies. The procedures are based on the introduction of a drug into the focus of the disease.funds. When compared with other methods of influence (massage, physiotherapy, medication, acupuncture, manual therapy), then drug blockade has been used not so long ago - no more than a hundred years. However, during all this time, the procedures managed to establish themselves as a very effective way to eliminate pain. That is the purpose of the blockade. Pain must be eliminated quickly enough, with a minimum number of side effects, time and material costs. It is the method of therapeutic blockade that fully corresponds to these conditions.
Description
Blockade is a temporary shutdown of one of the links from the arc of pain reaction. In addition to therapeutic, this procedure has a diagnostic value. In some cases, the specialist finds it difficult to make an accurate diagnosis. This may be due to the fact that clinical manifestations are duplicated, or the relationship between symptoms and objective data is not clearly traced. It also happens that neurological signs are not confirmed by MRI. Or, conversely, the indications of CT or magnetic resonance imaging are not clinically substantiated. In such cases, selective blockade will be of great help in establishing an accurate diagnosis.
Features
If soreness is reduced by anesthesia of specific anatomical structures, this indicates that they are the source of pain. Separate selective injections are carried out in a specific area. This ensures local anesthesia of the nerve,which supplies a certain area. An injection can also be made within the anatomical area, for example, an articular bag or a joint. As a result, nocireceptors in this zone are blocked. If corticosteroids are added in addition to the local anesthetic, selective injections in such cases may provide a longer therapeutic effect from anesthesia. Intra-articular steroids help reduce inflammation and reduce the discomfort associated with it. Such injections are used in cases where the joints do not respond to traditional effects - rest, drugs, physiotherapy. The blockade is used for myositis, radiculitis, neuralgia, sympathalgia. In addition to stopping the pain syndrome, there is an improvement in neurotrophic function.
Benefits of the procedure
The rapid onset of relief is ensured by the direct penetration of the drug into the pathological focus and the effect of the drug on the endings and conductors that spread pain. During the procedure, the likelihood of side effects is minimized. This is again due to the fact that the drug first penetrates into the focus of pathology, and then only into the systemic circulation. With each new exacerbation of the syndrome, it is allowed to apply the blockade repeatedly. Practice has established a positive therapeutic effect of injections. Thanks to the use of the blockade, muscle tension and vascular spasm are reduced, the inflammatory reaction and swelling in the painful focus are eliminated.
Paravertebral blockade
This concept should be considered collective. The term only indicates that the injection is carried out in the immediate vicinity of the spinal column. The injection can be intradermal, subcutaneous, perineural, intramuscular or radicular. In some cases, paravertebral blockade is used on the ganglia of the sympathetic border trunk. For example, a patient has a flattened disc. At the same time, there is a convergence of adjacent vertebrae and a decrease in the vertical diameter of the intervertebral foramen. In the anterior sections, its value increases due to the development of osteophytes and other bone growths. A decrease in the diameter of the hole occurs with the development of spondylarthrosis, thickening of the yellow, interarticular ligament and other processes caused by osteochondrosis. Due to the fact that the leading neurological disorders in nature are compression and irritation of the cord, but not infectious and inflammatory reactions of the membranes and roots, this variant of the pathology is usually called funiculitis. Based on this, the applied paravertebral blockade is funicular. Medicines are injected with a needle outward from the hole into the zone of the cord, and not to the spinal root.
Classification
Therapeutic injections are divided into types according to the drug used and the area of influence. So, there are:
- Paravertebral blockade of the cervical spine.
- Injections for intercostal neuralgia.
- Thoracic paravertebral blockade.
- Piriformis muscle.
- On the lumbar-sacral level.
- Sciatic nerve and others.
Use of glucocorticoids
Paravertebral blockade with "Diprospan" is used for systemic collagenoses. The drug at the cellular level stops the development of inflammation. Before the introduction of the drug, the area near the spinous process is chipped with anesthetics: the drug "Lidocaine" or "Novocaine". After that, the needle is replaced with a longer and thicker one and anesthesia is performed up to the vertebral arch. After that, a mixture of anesthetic with the drug "Diprospan" is injected. Contraindications to the procedure include diabetes mellitus, thrombophlebitis, osteoporosis in a pronounced course, psychosis, individual intolerance, infectious pathologies.
Using an anesthetic
Paravertebral novocaine blockade is a procedure, the essence of which is to inject the drug into the area of greatest pain. In particular, such areas include trigger points with overloaded joints and tense muscles, the passage of nerves and the location of their plexuses. Paravertebral blockade using an anesthetic may give a short-term effect (20-30 minutes). Nevertheless, even this time is quite enough to activate the normal tone of the spasmodic muscles.
Effectiveness of the procedure and contraindications
Efficiency is manifested by the removal of spasm throughout the muscle fiber, an increase in the motor volume in the joint, a decreasethe intensity of pain sensitivity locally or at the site of innervation of the nerve root. Paravertebral blockade, the technique of which will be described below, is not recommended for severe bradycardia, weakness syndrome in the sinus node, atrioventricular blockade of the second / third degree (the exception is cases when a probe is inserted for ventricular stimulation), cardiogenic shock, arterial hypotension (severe), hypersensitivity. Contraindications include a history of epileptiform convulsions provoked by anesthetics, as well as impaired hepatic function.
Procedure progress
How are paravertebral blocks performed? The execution technique involves carrying out manipulations in a certain sequence. The patient is first placed on the stomach. The area of maximum pain is determined by palpation. As a rule, this area corresponds to the projection of the cord, which has suffered the most. Neurological tests are also used to help determine where the paravertebral block will be performed. The injection technique should be well developed by a specialist.
The area is treated with alcohol or iodine. With the help of a thin needle, an anesthetic ("Novocaine") is injected into the area of the proposed injection until a "lemon peel" is formed. To approach the exit site of the cord, the second needle (longer) is inserted near the line of the spinous processes (at a distance of 3-4 cm) in accordance with the desired gap. As she entersinjection of a 0.5% solution of Novocain is carried out. The needle is inserted until it touches the transverse process. Further movement is carried out bypassing it from below or from above towards the spine at an angle of 30 degrees. relative to the sagittal plane. The needle is inserted another 2 cm deep and 10-20 ml of anesthetic or hydrocortisone emulsion is injected. So, in general, paravertebral blockades are performed. The execution technique involves the introduction of a needle in general by 5-6 centimeters.
Acute cases
There are several methods by which a paravertebral blockade is performed. The lumbosacral region is considered a rather problematic area, especially with acute pain and the absence of a clear monoradicular syndrome. In this regard, injections from three points are effective. The introduction is carried out between the vertebrae Liv and Lv, Lv and S1 and in the area of the first sacral foramen. The injection of the drug "Hydrocortisone" into these zones is caused by the most frequent damage to the spinal cords in them. The patient may be given a bilateral paravertebral blockade. The lumbosacral region in this case is chipped from six points. In accordance with the patient's condition, intensity and localization of pain, different dosages of the drug "Hydrocortisone" are used. When summing up to one cord (for 1 injection), 10-30 mg is used. With the correct implementation of the procedure, pain is reduced or eliminated immediately after the injection.medication. The blockade can be repeated if necessary. Repeated injection is allowed no earlier than after 2-3 days. After the procedure, the patient is recommended bed rest.
Other techniques
The patient assumes a prone position. His head should be turned away from the area where the paravertebral block will be performed. The cervical region is considered the most mobile area. In this regard, this area is injured more often than others. During the procedure, a 0.25% anesthetic solution is used at a dose of 70-100 mg. The injection needle is inserted perpendicular to the skin surface closer to the outer border of the back extensor. Further, the movement is carried out until it comes into contact with the damaged vertebra or transverse process. After that, the needle is shifted 0.5-1 cm to the side. Subsequent injections are carried out at a distance of 1.5 cm from the previous ones. In some cases, a mixture of drugs "Novocaine" and "Hydrocortisone" is used. The last one is taken 50-75 mg and the first one is brought to 100 ml.
Use Afonin mix
This is another method of performing a paravertebral lumbosacral block. To the site of the exit of the cord from the hole (intervertebral), 1.5-8 mg is injected. The total volume of the solution ranges from 30-80 ml. The dose depends on the number of points used in the blockade. The therapeutic course includes a single infiltration, if the result occurs quickly enough. If the effect appears slowly, then apply 2-4repeated blockades. Each next injection is carried out 5-6 days after the last one. When administered, the patient may experience various sensations in the region of innervation of the corresponding nerve fibers. For example, the patient may experience a feeling of heaviness, paresthesia, pressure, aching pain.
