Paravertebral blockade - what is it?

Elimination of the lumbar lumbar and pain of other localization is considered today as one of the most difficult but important tasks. Observing the regress of pain syndrome, we can conclude that the correct treatment is right. In accordance with modern representations of vertebrology, acute pain in the lower extremities or the spine should be eliminated as quickly as possible. When a condition passes into a chronic course, psychogenic disorders can arise. They, overlapping with common symptoms, complicate the therapy and significantly worsen the prognosis. In this connection, specialists tend to use as short as possible and at the same time effective methods. One such is the paravertebral blockade. What it is, how it is carried out - about this later in the article.

General information

Treatment blockades are considered to be 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 outbreak. If compared with other methods of exposure (massage, physiotherapy, medication, acupuncture, manual therapy), then the drug blockade is used not so long ago - not more than a hundred years. However, during this time the procedures have proved to be a very effective method of eliminating pain. It is this goal that is being pursued by the blockade. Pain must be eliminated quickly enough, with a minimum number of side effects, time and material costs. These conditions are fully consistent with the method of treatment blockade.

Description

A blockade is a temporary disconnection of one of the links from the arc of the pain reaction. In addition to therapeutic, this procedure has a diagnostic value. In a number of cases, the specialist finds it difficult to make an accurate diagnosis. This may be due to the fact that the clinical manifestations are duplicated, or the relationship between symptoms and objective data is not clearly traced. It also happens that neurologic signs are not confirmed with MRI. Or, conversely, indications of CT or magnetic resonance imaging are not clinically justified. In such cases, selective blockade will be of great assistance in establishing an accurate diagnosis.

Features

If soreness is reduced by anesthetizing anatomical specific structures, this indicates that they are the source of pain. Individual selective injections are carried out at a particular site. This ensures local nerve anesthesia, which supplies a certain area. The injection can be made and within the anatomical area, for example, an articular bag or a joint. As a result, nociceptors are blocked in this zone. If corticosteroids are added to the local anesthetic, selective injections in such cases can provide a longer therapeutic effect of anesthesia. Intra-articular injection of steroids helps to reduce inflammation and reduce the discomfort associated with it. Such injections are used in cases when the joints do not respond to the traditional effects - rest, drugs, physiotherapy. The blockade is used for myositis, radiculitis, neuralgia, sympatalgia. In addition to that the pain syndrome is stopped, there is an improvement in the neuro-trophic function.

Advantages

A rapid onset of relief is provided by the direct penetration of the medication into the pathological focus and the effect of the drug on the endings and conduits that spread soreness. During the procedure, the likelihood of side effects is minimized. This is again due to the fact that the medicine penetrates first to the focus of pathology, and then only - to the systemic bloodstream. With each new exacerbation of the syndrome it is allowed to apply the blockade repeatedly. Practice has established a positive therapeutic effect of injections. Due to the use of blockade, muscle tension, vascular spasm, inflammatory reaction and puffiness in the painful focus are eliminated.

Paravertebral block

This concept should be considered collective. The term indicates only 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 a number of cases, the paravertebral blockade is applied to the ganglia of the sympathetic border trunk. For example, the patient has a flattened disc. At the same time, convergence of adjacent vertebrae and a decrease in the vertical diameter of the intervertebral foramen are noted. In the anterior regions, its size increases due to the development of osteophytes and other bone growths. Reduction of 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 in the nature of neurological disorders is compression and irritation of the cord, but not the infectious and inflammatory reactions of the membranes and roots, this variant of pathology is usually called funiculitis. Based on this, the applied paravertebral blockade is funicular. Medicaments are injected with a needle outward from the opening into the zone of bedding 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 exposure. So, there are:

• Paravertebral block of the cervical spine.
• Injection with intercostal neuralgia.
• Thoracic paravertebral block.
• Pear-shaped muscle.
• At the lumbosacral level.
• The sciatic nerve and others.

Application of glucocorticoids

Paravertebral blockade with "Diprospan" is used for systemic collagenoses. Medication at the cellular level stops the development of inflammation. Before the introduction of the medicine, the area near the spinous process is impaired by anesthetics: the drug "Lidocaine" or "Novocain." After that, replace the needle with a longer and thicker one and make anesthesia to the vertex arch. After this, a mixture of anesthetic with the drug "Diprospan" is injected. Contraindications for the procedure include diabetes mellitus, thrombophlebitis, osteoporosis in the marked course, psychosis, individual intolerance, infectious pathologies.

Use of anesthetic

Paravertebral novocain blockade is a procedure, the essence of which is to introduce the drug into the zone of greatest soreness. In particular, such areas include trigger points with overloaded joints and strained muscles, areas of passage of nerves and the location of their plexuses. Paravertebral blockade with the use of anesthetic can give a short effect (20-30 minutes). Nevertheless, even this time is quite enough to activate the normal tone of the spasmodic musculature.

Efficacy of the procedure and contraindications

The effectiveness is manifested by the removal of spasm throughout the entire muscle fiber, an increase in motor volume in the joint, a decrease in the intensity of pain sensitivity locally or in the area of innervation of the nerve root. Paravertebral blockade, the technique of which will be described below, is not recommended, with severe bradycardia, weakness syndrome in the sinus node, atrioventricular blockage of the second / third degree (except for cases where a probe is inserted for stimulation of the ventricles), cardiogenic shock, arterial hypotension (pronounced), hypersensitivity . Contraindications include the availability of data on epileptiform cramps in history, provoked by anesthetics, as well as a violation of the hepatic function.

Procedure

How is paravertebral blockade performed? The technique of execution involves carrying out manipulations in a certain sequence. The patient first falls on the stomach. The method of palpation determines the site of maximum soreness. As a rule, this area corresponds to the projection of the cable, which suffered the most. Neurological tests are also used to help establish the place where the paravertebral blockade will be performed. The technique of injection should be well worked out by a specialist.

The site 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 crust" is formed. To approach the exit site of the cord, a second needle (a longer one) is inserted near the line of spinous processes (3-4 cm apart) in accordance with the desired interval. As it enters, an injection of 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 in a direction to the spine at an angle of 30 degrees. Relative to the sagittal plane. The needle is inserted another 2 cm deep and injected with 10-20 ml of anesthetic or hydrocortisone emulsion. So, in general, paravertebral blockades are carried out. The technique of implementation 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 section is considered to be a problematic area, especially with acute pain and lack of a monoradicular clear syndrome. In this connection, injections from three points are effective. Introduction is carried out between the vertebrae Liv and Lv, Lv and S1 and in the area of the first sacral orifice. The injection of the preparation "Hydrocortisone" into these zones is caused by the most frequent injuries in them of the spinal cord. The patient may be assigned a bilateral paravertebral block. The lumbosacral section in this case is cut from six points. In accordance with the patient's condition, intensity and localization of pain apply different dosages of the drug "Hydrocortisone". When applied to one cord (per 1 shot), 10-30 mg is used. With the proper implementation of the procedure, soreness is reduced or eliminated immediately after the administration of the medication. The blockade can be repeated if necessary. Repeated injection is allowed no earlier than 2-3 days. After the procedure, the patient is recommended bed rest.

Other methods

The patient assumes a supine position. His head should be turned in the opposite direction from the area where the paravertebral blockade will be caused. The cervical region is considered the most mobile site. In connection with this, this zone is traumatized more often than others. During the procedure, 0.25% solution of anesthetic in a dose of 70-100 mg is applied. The injection needle is inserted perpendicular to the skin surface closer to the outer border of the extensor of the back. Further movement is carried out before contact with the damaged vertebra or transverse process. After that, the needle is displaced 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." The last take 50-75 mg and bring the first to 100 ml.

Using a mixture of Afonina

This is another method of conducting a paravertebral lumbosacral blockade. To the exit site of the cord from the hole (intervertebral), 1.5-8 mg is administered. The total volume of the solution varies between 30-80 ml. The dose depends on the number of points used for blockade. The therapeutic course includes a single infiltration, if the result occurs quickly enough. If the effect appears slowly, then 2-4 repeated blockades are used. Each next injection is carried out 5-6 days after the last. Upon administration, the patient may experience various sensations in the innervation region of the corresponding nerve fibers. For example, a patient may experience a feeling of heaviness, paresthesia, pressure, aching pain.