Blockade of the spine: types, purpose, preparations, consequences

Pain syndrome is the main manifestation of the clinical picture of the pathology of the musculoskeletal system, in particular, the spine. The occurrence of acute vertebral pain should be arrested immediately, even given that the fight against morbidity is not etiotropic therapy. Blockade of the spine is one of the activities that takes place in the complex treatment of vertebrology problems.

General concepts

It is harder for specialists to stop chronic pain syndrome than acute back pain, since manifestations begin to have a central character. That is, the focus of morbidity is formed not at the level of excitation of local receptors, but in the brain. Treatment of this condition is longer and requires the use of antidepressants and antipsychotics.

To prevent this, symptomatic therapy already at the early stages of the disease uses such manipulation as blockade of the spine. What this is and how the procedure is carried out, we will consider further.

A blockade is the exclusion of a link from the mechanism of fighting pain, using medicinal analgesics. In addition to the therapeutic purpose, the blockade of the spine is used for diagnosis. The pain of unspecified localization requires the introduction of anesthetics, which allows an elimination method to determine the pathology development department. As a rule, the pain syndrome "turns off" instantly after the manipulation.

Indications

Diseases of the musculoskeletal system, requiring the use of blockade, must necessarily be accompanied by painful manifestations. In the opposite case, the use of medicines for this purpose is not relevant. The procedure is performed in the following pathologies:

• Osteochondrosis;
• Presence of a herniated intervertebral disc;
• Deforming spondylosis;
• Radiculopathy;
• Traumatic injuries;
• Neoplasm of intervertebral space;
• Lateral narrowing of the spinal canal.

The procedure is carried out in those cases if there is no effect of conservative treatment. Efficacy occurs after the first injection, however, severe forms of diseases require 2-3 to 15 manipulations, carried out at intervals of several days.

Advantages of the blockade are quick effectiveness, a minimum of side effects while observing the rules of conduct, the possibility of repeated use. In addition to anesthesia, manipulation has an anti-inflammatory and antispasmodic effect, which depends on the selected drugs.

Classification of vertebral blockades

Depending on the number of drugs, introduced at the same time, different manipulations:

• Monocomponent (one agent);
• Dicomponent (two agents);
• Polycomponent (three or more tools).

Analgesic injections are injected into the following anatomical departments:

1. Departments of the spine - thoracic, cervical, lumbar, sacrum.
2. Nerves - sciatic, occipital, tibial, suprathapathic, posterior branches of spinal nerves.
3. Muscular apparatus - the muscles of the head, pear-shaped muscle, front staircase.
4. Epidural and epidural space.
5. Facet joints.
6. Joints - sacroiliac and sacrococcygeal.

Blockades in the hernia of the spine are divided into two types:

1. Transforominal administration is characterized by injecting the drug into the exit apertures of nerve endings.
2. In the intralaminar procedure, medication is inserted between the vertebral spines directly into the cartilaginous disc.

Contraindications

Blockade of the spine has certain contraindications, which the doctor takes into account when examining the patient. Each clinical case is considered individually, clarifying the possible risk of developing side effects. The procedure is not performed under the following pathological conditions:

• Diseases characterized by a tendency to bleed;
• Systemic infectious diseases and local manifestations in the puncture area;
• Unconsciousness of the patient;
• Individual intolerance of the medicines used;
• Heart and vascular disease;
• epilepsy;
• Arterial hypotension;
• Mental illness;
• childhood;
• Period of pregnancy and lactation;
• Organic lesions of the liver and kidneys.

Local anesthetics

Substances that provide analgesic effect, are used for all types of blockades, using the drug in its own form or in combination with other groups of medicines.

Novocaine blockade of the spine is performed more often than other injections of anesthetics. Novokain is available in the form of a solution for injections with different concentrations of active substance (from 0.25% to 2%). The analgesic effect develops a few minutes after the blockade has been carried out. The injection with the application of "Novocaine" anesthetizes up to 2 hours.

Marcain is also used to stop the pain syndrome. The result of the introduction of the tool has a late start. The pain disappears after 20 minutes, but the duration of the action can reach 5-6 hours. The use of "Markain" is carried out only after a thorough examination of the patient's heart and blood vessels.

The next local anesthetic used to combat vertebral pain is Lidocaine. The price of the drug is in a low category (about 30 rubles per package), which makes it affordable for use. The drug is characterized by a quick action and a longer time than Novokain.

"Novocain" and "Lidocaine", the price of which is more than available, are used more often than other local anesthetics. Before using any of them, it is necessary to check the individual sensitivity of the patient to prevent the development of an allergic reaction.

Hormonal preparations

Preparations of the hormonal composition in the therapy of vertebral column pathologies in the form of independent administration are used extremely rarely. Most often they are used to treat joints. Blockade of the spine requires a combination of corticosteroids with other drugs (eg, anesthetics). Hormonal drugs reduce pain, stop inflammation, reduce puffiness and allergic manifestations.

The agents used in vertebrology:

1. "Prednisolone" is mixed with one of the analgesic drugs (Procaine, Lidocaine, Novocaine). It is effectively used for blockade with a hernia of the spine, radiculitis, osteochondrosis.
2. "Hydrocortisone" is used for blockade of nerves. Mix thoroughly with the anesthetic before administration.
3. "Diprospan" is used for any kind of pain relief. The drug is good for rapid development of the effect and prolonged action.
4. Means "Kenalog", in addition to anti-allergic and anti-inflammatory, has an immunosuppressive effect. It is used for any type of blockade and joint treatment.

Other groups of medicines

The rest of the drugs do not have an analgesic effect. They are used in the composition of polycomponent blockades and include the following drugs:

• Non-steroidal anti-inflammatory (Voltaren);
• Vitamins of group B;
• Enzymes ("Lidase", "Papain");
• "ATP";
• Antispasmodics ("Platyphylline");
• "Thrombolizine";
• Chondroprotectors ("Rumalon").

Example of the procedure

Consider the example of manipulation. Novocain blockade of the lumbar spine is performed in the supine position. Palpating the injection site, it is treated with an antiseptic solution. Using a thin needle, the drug is injected intradermally to form a "lemon peel".

Then the needle is replaced by a longer one and inserted between the necessary vertebrae a few centimeters lateral to the spinous processes. As the needle is inserted, a small amount of solution is dispensed portionwise. Introduced to the limit in the process. Then, the needle is partially pulled back and directed to the scion no more than 2 cm. 5 ml of the solution is injected at the level of each segment of the spinal column.

The blockade of three main points is carried out: between the 4th and 5th lumbar vertebrae, between the 5th lumbar and the 1st sacral, in the region of the 1st sacral orifice. In severe pain syndrome, bilateral manipulation is performed using six points. The procedure takes about 40 minutes of time. For several hours after anesthesia, the patient is under the supervision of specialists.

Epidural blockade of the spine - what is it?

Epiduritis and lumbosacral radiculitis are indications for epidural administration of analgesic medications. When anesthetizing the lumbosacral spine, the patient is located on his side, bringing his legs bent at the knees to his stomach. The rear passage is insulated with sterile towels or sheets. The field is disinfected in the place of future administration of the drugs.

In the projection of the lower sacral orifice, intradermally, the drug is administered. Then the needle is changed and inserted in parallel, piercing the membrane of the entrance to the sacral canal. Further, the needle descends almost horizontally to a depth of not more than 5 cm, by monitoring the liquid, by pulling the piston toward itself. In the absence of content, a drug is administered. The patient can feel pressure and raspiranie in the coccyx.

The maximum volume of drugs administered per manipulation is 60 ml. Epidural blockade allows the use of:

• novocaine;
• Cyanocobalamin;
• Thiamine;
• Corticosteroids.

Possible complications

All types of anesthesia should be carried out exclusively by a qualified specialist under sterile conditions. The blockade itself, the injection, the treatment of the field and all other parts of the procedure require strict compliance with asepsis. Disregard for the procedure can affect the patient's health and lead to the development of the following complications after the blockade of the spine:

• Bleeding due to damage to the integrity of the vessels;
• Severe pain at the injection site;
• Violation of breathing when the drug enters the subarachnoid space ;
• Allergic reactions;
• collapse;
• Disruption of the bladder;
• Infection of the spinal cord and puncture area;
• Neurological reactions;
• Damage to the nerves, blood vessels, ligaments or the muscular apparatus with a sloppy procedure.

Conclusion

Blockade of the spine, which is confirmed by a positive result of the procedure, is almost the only way out in the absence of the effectiveness of conservative therapy. Obligatory conditions for a favorable outcome are a thorough examination of the patient and strict adherence to aseptic and antiseptic rules during manipulation.