Blockade paravertebral with hernia lumbar spine and other diseases

Paravertebral block (spine)

Blockade of the spine is a special medical procedure that

helps quickly to stop acute painful attacks and relieves pain for a long time. Paravertebral blockade -collective term for injecting near the spine.

The procedure for arresting pain is carried out both for therapeutic purposes and as a diagnostic measure.

If the localization of pain is not specified, there is no diagnosis, thenafter the introduction of painkillers by exclusion method, the department for the development of pathology.

Indications

Blockade is performed only in those cases when the disease is accompanied by acute pain. In a nasty situation, the expediency of the procedure becomes irrelevant. The event is appointed if conservative treatment does not yield any results.

The blockade can be carried outnot more than four times a year.

The indications are as follows:

• osteochondrosisany department of the spine - dystrophic disorders in the joint parts, usually damaged intervertebral discs. Doctors make a blockade in case of osteochondrosis of the cervical spine, as well as of the thoracic and lumbar regions;
• deforming spondylosis- Defensive reaction of the body to osteochondrosis. The disease lies in the fact that on the lateral parts of the vertebrae, osteophytes grow (bone growths). They affect the work of the entire body, cause great discomfort and pain. Osteophytes do not disappear on their own; complex treatment is necessary;
• herniation of intervertebral discs- a disease in which a fibrous ring is broken and a displacement of the pulpous nucleus occurs. Usually there are hernias of the lumbar spine, much less often - cervical and thoracic;
• radiculopathy- neuralgic or radicular syndrome. Occurs in the process of squeezing the spinal nerves, accompanied by acute painful attacks;
• spinal stenosis- a chronic and progressive pathology, in which there is a narrowing of the central canal of the spine. Usually affects people of advanced age;
• neoplasm in the intervertebral space- is expressed by tumors;
• spine injury, which are traumatic.

Benefits

1. Effective result - as a rule, doctors prescribe one injection, after which the patient feels relief. In advanced cases with a severe form of the disease, an injection course is required: from two to fifteen procedures.

   The interval between injections is five days.

2. Along with the analgesic effect, the blockade removes the edema from the nerve roots, has an antispasmodic and anti-inflammatory effect.
3. If the procedure is done correctly, complications in the patient almost never arise.

Caveats

Paravertebral blockade -serious medical procedure. Before it is performed, the patient must be diagnosed.

Pregnant women are not recommended. Exceptions - only on the prescription of a doctor, in cases where the life of a woman is at risk.

Old age is not a strict restriction, but the blockade for people over 65 is done with greater caution.

Contraindications

Despite the effectiveness of the blockade of the spine, there are a number of limitations to this exercise. Among them are:

• tendency to hemorrhage - hemophilia, thrombocytopenia, systematic reception of anticoagulants;
• heart disease, in particular, arrhythmia - this is due to the fact that anesthetics affect the rhythm of cardiac contractions;
• individual intolerance to medications that should be used;
• low blood pressure;
• myasthenia gravis;
• epilepsy;
• hepatic and renal insufficiency;
• severe condition of the patient, including lack of consciousness;
• Contraindications to the use of corticosteroids;
• infection of the skin at the injection site, a common infectious disease - this increases the risk of spreading microorganisms throughout the body;
• children's age of patients.

Side effects and consequences

Treatment of the injection site of the syringe, the injection itselfrequire strict compliance with aseptic rules. Neglect of them will affect the patient's health. Side-effects can be the following:

• dysfunction of the bladder;
• neurological reactions from the nervous system;
• violation of breathing (if the drug enters the subarchnoid space);
• collapse;
• severe pain in the injection site.

Possible complications

Any blockade of the spine, regardless of the species,can lead to complications. These include the following:

• damage to soft tissues (muscles, nerve fibers, blood vessels) - it is possible if the needle is inserted in the body inaccurately;
• infection of the spinal cord or needle insertion site - the probability of this complication depends on the sterility of the instruments and the location of the procedure;
• bleeding;
• allergic reactions to injections;
• specific complications that are associated with the introduction into the body of the main drug substance (corticosteroids or anesthetics).

Do they do it at home?

The patient often can not reach the hospital because of strong pain and ill health.

For example, a patient could "twist" the pain due to hernia, he urgently needs a Novocaine blockade with a herniated spine at home.

In exceptional cases, it is possible to perform the procedure at home.

Not every clinic provides such a service, so first you need to clarify whether your medical center offers a blockade at home, after which you can leave a request.

Usually the doctor makes an inspection, diagnoses the disease and stops the pain with the help of a prick in just one day.

Preparations for blockade

Doctors divide the blockages of the spine into several types, based on the introduction of medicines:

• one-component - procedures, in which one type of medicine (anesthetic or corticosteroid) is introduced into the body;
• two-component - blockades, during which two different preparations are mixed;
• multicomponent - a medical measure when the injection consists of three drugs.

Local AnestheticsAre substances that, when in contact with nerve fibers, delay the conduction of nerve impulses. That is, they eliminate for a time the pain reflex and other sensitivity at the site of the injection.

Anesthetics can be stabbed as an independent drug, and in conjunction with corticosteroids and other drugs.

NameDescriptionContraindicationsPrice

Novocaine	Issued in the form of a solution for injection. Valid after 2 - 5 minutes. Anesthesia lasts up to 2 hours.	Heart and kidney failure, liver disease, age under 18 and after age 65, proctitis, hypersensitivity to the drug.	From 17 rubles
Lidocaine	A popular anesthetic, acts a couple of minutes after the injection. The effect lasts up to 3 hours.	Bleeding, arterial hypertension, bradycardia, severe dysfunction of the liver.	From 15 rubles
Bupivacaine	The action begins in 10 - 20 minutes. The effect lasts up to five hours. The drug may be toxic to the heart.	Hypotension, central nervous system diseases, hypersensitivity to components, children's age.	From 832 rubles

Hormonal remedies- drugs of this category are rarely used for blockade as an independent component. Usually they are combined with anesthetics or other drugs.

Corticosteroids help reduce pain, relieve swelling and inflammation.

NameDescriptionContraindicationsPrice

Hydrocortisone	Suspension, it is thoroughly mixed with anesthetic. Effective in neural blockade	Allergic reactions to the drug, arterial hypertension, myasthenia gravis, fungal diseases, nephritis and so on.	From 13 rubles per ampoule
Dexamethasone	Acts quickly, but for a short time. Effective for blockages of joints and soft tissues	Renal and hepatic insufficiency, hypertension, endocrine diseases, poliomyelitis, elevated lipid levels in the blood.	From 23 rubles
Kenalog	Applied for relief of pain and joints, and the spine.	Gastric ulcer, bone atrophy, viral and infectious diseases, glaucoma.	From 96 rubles
Diprospan	Substance of prolonged action. Quickly removes pain in the spine and joints.	Diabetes mellitus, renal failure, liver disease, skin lesions, stomach ulcers.	From 209 rubles

All drugs (the first and second groups) can not be used during pregnancy, during lactation. Contraindications are children's age and individual intolerance of the drug.

Other components- medicines that are used as additional funds. They are part of two- and multi-component blockades.

These include B vitamins, enzymes, spasmalytics, hondoprotectors and others.

Types of procedures

In medical practice, there are many types of blockages of the spine. The necessary procedure can be chosen by a specialist.

The choice depends on the specific case, the clinical picture, the goal pursued.

So the blockade in osteochondrosis of the lumbar spine requires one intervention, and with stenosis, a completely different kind of procedure is selected.

Based on the effect on tissue or nerve fibers, the blockade of the spine may be of the following types:

• The tissue procedure - the injection is made into the soft tissues that surround the affected area of ​​the spinal column;
• receptor blockade - the injection is made into biologically active points located on the skin integuments, tendons, muscles, ligaments;
• conductor type of blockade - during this procedure, nerve fibers are blocked. The drug can be administered by epidural, epidural, paravascular, perineural and paraneural methods;
• Ganglion blocking is a procedure during which the injection is made into the nerve nodes and the nerve plexuses.

The procedure of anesthesia depends on the place of injection. The blockade of the spine can be of several kinds.

• cervical - procedure, when the injection is made into the cervical region of the spine;
• chest - blockade, in which the injection is injected into the thoracic spine;
• lumbar - a procedure that presupposes the introduction of medicine into the lumbar region of the spine.
• sacral - injections are made into the sacrum.

Technique of blockade

1. The patient should lie on his stomach. The doctor palpates it and finds the most severed cord (the most painful place).
2. Then the doctor, using neurological tests, chooses the place of the patient's nerve root, wipes it with alcohol.
3. Conducts local anesthesia - splits the alleged injection site with novocaine.
4. At the next stage, a long needle is inserted to a depth of five to six centimeters and novocaine is injected (solution,%).

Epidural blockade according to Catlen

This procedure is anesthesia of the spinal nerves. The medicine is injected into the epidural space, in the immediate vicinity of the nazhott rootlets.

If the needle is inserted deeply, Novocain can penetrate into the subarachnoid space, which will lead to undesirable consequences.

Indications for the procedure are acute forms of radiculitis of the lumbar and sacral region, epiduritis of aseptic or reactive form.

After this, the epidural blockade is performed. Usually a syringe with a needle of 5 to 6 centimeters is used. The body is injected from thirty to sixty milliliters of novocaine.

Watch a video on this topic

Peridural blockade

One of the most common methods of anesthesia. The medicine is injected next to the nerve roots. This leads to a quick result. The procedure takes no more than thirty minutes, then the patient has another two hours under the control of doctors.

Usually, 40 milliliters of novocaine are injected into the affected area. Sometimes it adds hydrocortisone and vitamin B.

If blockages were made in the hernia of the spine, then the patient can not sit behind the wheel for another 12 hours.

Vertebral blockade - an effective procedure that allows you to quickly get rid of the pain associated with the pathology of the spine. You can not treat her scornfully.

Incorrect performance of the procedure can lead to serious consequences and impairment of health.

How to forget about joint and spinal pain?

• Does pain limit your movements and full life?
• Are you worried about discomfort, crunching and systematic pain?
• Perhaps you have tried a bunch of medicines, creams and ointments?

A source: http://zdorovya-spine.ru/preparaty-i-lekarstva/blokada/pozvonochnika.html

Features of the paravertebral blockade

Surgical interventions

With acute pain in the back, when treatment does not bring results and the long-awaited disposal of symptoms, resort to the method of arresting pain in the spine with the help of a paravertebral blockade.

The term "paravertebral blockade" is a collective term, implying injections with an anesthetic into the near-vertebral region of the back.

It is applicable in cases where other types of treatment are tried, and acute pain, swelling and inflammation in the vertebral departments do not pass.

The main advantages of this method are:

• rapid analgesic action;
• possibility of repeated procedure in case of relapse;
• little chance of side effects;
• removes inflammation, swelling and has an antispasmodic effect.

The choice of the technique of administration depends on the patient's illness and the anamnesis. The doctor individually selects the method by which the injection will be made:

• tissue blockade is carried out through tissues located in the area of ​​the affected area of ​​the spine;
• conductor blockade causes numbness of nerve fibers. It is carried out by injecting the drug into the space around the nerve trunk or into the fatty tissue of the cerebral membrane;
• Ganglionic blockade is introduced into the plexus of the nerve nodes.

The blockade in neurology is used not only for anesthesia, but also for clarifying the diagnosis. A correctly diagnosed diagnosis helps to choose a method of treatment and determine the necessity of using the blockade in the future.

In its composition, injection of the blockade can be single-component (only an anesthetic is used), two-component (two types of drugs are used) and multicomponent (when used from three drugs and more).

As anesthesia apply:

• Novocain - its effect is observed after 2 minutes and lasts up to 2 hours;
• lidocaine - anesthetizes for 3 hours;
• Mercamine - lasts for 5 hours after administration, but is rarely used due to side effects.

When choosing an anesthetic, we take into account both how much the drug works and the possibility of combining it with other components in the injection. To avoid allergic reactions, the patient is tested for sensitivity to the drug.

In two-component and multicomponent blockades, corticosteroids are used to relieve swelling and inflammation: Diprospan, Dexamethasone, Hydrocortisone, Kenalog. They also have an anti-allergic property.

To enhance the therapeutic effect in the multi-component blockade add: vitamins B, Platifillin (has a sedative and spasmolytic effect), Lidase (promotes healing and enhances the permeability of tissues) and other drugs that help in treatment of the disease.

Most often, this procedure is performed with a degenerative-dystrophic lesion of the vertebral column, when tissue degradation is at a late stage. Diseases in which you can put a blockade:

• osteochondrosis;
• radiculitis;
• herpes zoster;
• intercostal neuralgia;
• spine trauma;
• muscle spasms;
• pinched nerves of the spinal canal.

Blockade of the nerve of the spinal cord stops carrying pulses along it and suppresses the receptors. Typically, one procedure is enough. Otherwise, the blockage can be repeated up to 15 times, but with a break of 3-6 days. The course of treatment can not be conducted more often 4 times a year.

There are reasons why any technique of blockade is prohibited:

• the patient is unconscious;
• poor blood clotting, tendency to bleeding (hemophilia);
• low platelet count (thrombocytopenia);
• allergic reaction of the patient to the active drug;
• heart disease;
• epilepsy;
• fatigue of striated muscles (myasthenia gravis);
• various mental illnesses;
• low blood pressure (hypotension);
• childhood;
• various infectious diseases;
• severe liver disease and kidney failure;
• period of pregnancy and lactation.

The procedure is carried out in several ways. They are distinguished by the introduction of a needle to deliver drugs to the focus of pain. The choice of one or another method depends on the patient's condition and the reasons for the appointment of the blockade.

The patient lies on his stomach. The doctor with the help of palpation determines the most painful place on the spine and treats it with an antiseptic. Then, using a thin needle, this place is anesthetized, applying an anesthetic before the formation of a "lemon crust".

With a thicker needle, inject 0.5% solution of novocaine at a distance of about 4 cm from the spinous processes. Novocain is administered evenly as the needle moves inward. At a depth of 2 cm, add up to 20 ml of the solution. The maximum depth of the needle is 6 cm.

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Since the lumbosacral section is more often injured due to the fact that the intervertebral foramen in this area is the narrowest, and the spine completely covers it, the blockade is also carried out here. If the pain is unilateral, then it is sufficient to administer the drug from three points. If the pain is from two sides, then it will take six injections.

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Depending on the patient's well-being and the nature of pain, a different dose of hydrocortisone is used. One injection (three or six) requires up to 30 mg of the drug.

After the first procedure, the pain passes completely or noticeably subsides. Repeat the blockade only after 3 days.

The place in which the blocking needle will be injected is chewed with novocaine until a "lemon crust" is formed. Then, the needle is inserted over the spinous process or at the outer edge, advanced along its lateral surface, touching the bone. Novocaine is injected evenly as the needle moves.

When the needle reaches the spine of the spine, bone resistance is felt - the needle is deflected towards the middle and is advanced by another 1.5 cm along the back surface of the arch. The needle position is fixed and additional 15 ml of novocaine are injected.

Given that one affected vertebra is extremely rare, blockade is placed at the level of three immediately adjacent vertebrae.

This technique is convenient because, even with bilateral pains, you can do only three punctures. In this case it is recommended to apply 0.25% solution of novocaine.

• Paravertebral blockade with B. A. Afonina.

Composition of the mixture:

1. 1. pahikarpine hydrochloride g;
2. 2. platifillin hydrotartrate 3 g;
3. 3. novocaine 5% - 20 ml.

It is used for radicular blockade. The total volume of the solution administered, depending on the number of punctures, is up to 80 ml.

Up to 8 ml is applied to the cord, taking into account the type and severity of the disease.

In most cases, a single application is sufficient, but, if necessary, the procedure is repeated only after 6 days. One course can consist of no more than 4 blockades.

At the time of the procedure, the patient feels the heaviness, pressure or aching pain at the puncture site.

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Epidural blockade is a blockade of the roots of the nerves of the spinal cord. The active ingredient is novocaine, it is injected into the area of ​​the sacral spine. Since the drug enters the fatty tissue of the epidural layer, the procedure is considered absolutely harmless to the patient.

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This method is prescribed for radiculitis and epiduritis. Especially necessary epidural blockade in the hernia of the lumbar spine, but it has no effect in the arachnoid and meningoradiculitis or in the treatment of neuritis of the sciatic nerve.

Method of conducting:

1. 1. The patient becomes on all fours or lies on one side, pressing his knees to his chest. The back passage is isolated with tampons and a sterile towel.
2. 2. After disinfecting the surface of the skin, the doctor gropes for the entrance to the sacral canal. This place is anesthetized with a very thin needle.
3. 3. A needle of 6 cm produces a sharp puncture of the skin, subcutaneous tissue and membrane. Then the needle is lowered almost horizontally and injected 4 cm into the sacral canal. Control over the passage of the needle is carried out by suction with a syringe: if it appeared in it cerebrospinal fluid, the procedure is terminated and the blockade is attempted again only through day.
4. 4. If blood appears in the syringe, then the needle is retracted to its original position, and then repeated the injection again, controlling it by filling the syringe. In the absence of blood and cerebrospinal fluid, begin the introduction of novocaine, very slowly, in small portions, without any sense of resistance. At the same time, the patient feels a raspirnie, rising on the vertebral column.
5. 5. After the procedure, the patient is under observation in the hospital. He should spend about an hour horizontally on the sore side.

Blockade of the lumbar spine is performed using 30 to 60 ml of novocaine. Together with it can introduce vitamins B1 and B12. In addition, blockades of novocaine with corticosteroids are used. It is effective in discogenic radiculitis, when there is inflammation and edema.

The most common procedure to date. The technique of implementation is that the drug is injected into the epidural space.

The blockade of the spine with a hernia in this area is most effective.

Method of conducting:

1. 1. The patient lies on the sore side. The puncture site is treated and anesthetized. For the procedure, a puncture needle with a mandrel (a wire rod that closes the needle lumen) is used.
2. 2. To get into the epidural space, the needle passes about 6 cm. After the introduction of 2 cm, the mandrels are removed and the syringe is attached to the solution of novocaine. A bubble of air is necessarily present under the syringe plunger.
3. 3. Then the procedure is carried out by lightly pressing the piston. If it springs out, and the air ball shrinks - the needle is in the vertebral ligaments. The termination of the resistance of the piston indicates that the needle has reached the epidural space. The medicine begins to flow into it freely.
4. 4. In order to make sure if the needle has hit the epidural space, rather than piercing the hard shell of the spinal cord, the syringe is disconnected and watched - whether the fluid will leak out of the needle. An additional way to make sure that the needle is in the right place is the difference between atmospheric pressure and pressure in the epidural space (here it is below atmospheric pressure). To the inserted needle bring a drop of solution on the tip of the syringe. If the drop "drags" towards the needle clearance - the procedure is carried out correctly.
5. 5. Novocaine is administered slowly, in small doses. The total volume of the drug is up to 40 ml. Sometimes together with him, hydrocortisone and vitamin B1 are used.

The peridural blockade is a rather complicated procedure. In the event that novocaine was introduced into the subarchoidal space, the patient is threatened with respiratory arrest.

To provide first aid, the patient is placed in a sitting position, the doctor removes 20 ml of cerebrospinal fluid and watches for a few hours.

Indications for blockade of the sympathetic trunk are:

• trophic disorders (malnutrition of cells);
• circulatory disturbance;
• pain syndrome (chronic pain).

The main advantage of this procedure is the expansion of the vessels. Elimination of vasospasm leads to an improvement in blood flow and a reduction in pain.

Diseases in which it is possible to make a blockade of the sympathetic trunk:

• thrombosis of cerebral vessels;
• a syndrome of the vertebral artery and vertebral nerve ("cervical migraine");
• neuropathy and neuralgia;
• Raynaud's syndrome (spasm of small vessels);
• causalgia (severe burning pain with peripheral nerve damage).

The patient lies on his back, his head turns his head to the doctor. The needle is inserted perpendicular to the bone, then its direction is changed anteriorly. Anesthetic is fed along the posterior margin and at the middle of the sternocleidomastoid muscle.

The blockade of the sympathetic trunk is a rather complicated procedure. A qualified neurologist should be well versed in the anatomical features of the patient. Novocaine,%, 1% and 2% are used for this blockade.

Weight lifting or a sedentary lifestyle cause degradation of the tissues of the vertebral discs and lead to the appearance of osteochondrosis, which flows into the destruction of the disk's core - a hernia.

To anesthetize and remove the edema in hernia and osteochondrosis, the epidural blockade method is used. In this case, the peridural blockade of the spine is less frequent because of its less long-term effect.

At the injection site, there are two ways to carry out the procedure:

• Intralaminar - the drug is injected between vertebral spines.
• Transforominal - injection is carried out in the holes of the nerve exit of the spinal cord.

When carrying out a blockade of the lumbar spine, both methods are used. They are both effective, but relieve the symptoms only for a while.

Blockade in osteochondrosis of the lumbar region is appointed in the event that the dystrophic changes began in the lumbosacral region.

Before the blockade of the intervertebral hernia is prescribed, an additional examination using magnetic resonance and computed tomography is performed.

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The epidural blockade itself occurs under the control of a contrast medium and a fluoroscope. The procedure takes no more than an hour.

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Under the supervision of the doctor, the patient is still about two hours. Probably the appearance of numbness in the limbs and weakness. These symptoms go away after a few hours.

The car can be operated 12 hours after the blockade.

Blockade of the cervical spine is performed when the patient sits or lies on his side. The doctor produces a puncture at the level of the sixth vertebra of the cervical region.

During the blockade with osteochondrosis, in addition to novocaine, such drugs as chlorprokain, bupivacaine or ropivacaine are used.

An improperly made puncture can lead to:

• spinal cord injury and paralysis;
• migraines and back pain;
• infection and the development of meningitis or myelitis.

In order to avoid such complications, the patient should refer to a proven specialist. Such procedures can be performed only by a highly qualified doctor.

A source: http://spina-health.ru/paravertebralnaya-blokada/

In what cases is a paravertebral blockade of the lumbosacral section: indications and contraindications, medications used

Back pain significantly complicates a person's life, restricts motor activity.

Any attempt to perform some kind of movement can result in increased pain syndrome.

Especially often, vertebral pathologies suffer from the lumbosacral department, which accounts for the greatest burden.

To eliminate acute and shooting back pain, various methods of treatment are used. One of the fastest is the paravertebral blockade.

This is the injection of certain medicinal mixtures into the affected area in order to quickly "disconnect" the pain syndrome.

Although the blockade is a palliative method of treatment, but at the same time the fastest.

general information

Paravertebral blockade is a collective concept. The term "paravertebral" means the one that is carried out in close proximity to the vertebral column.

With lumbosacral pain, the injection is injected into the most painful area near the exit of the nerve endings.

This makes it possible for a while to stop the pain attack, strengthen the nerve supply, remove the swelling.

In addition to the therapeutic purpose to anesthetize the affected area, paravertebral blockades have a preventive effect of accompanying pathologies.

Chronic pain can cause muscle spasms, disrupt the functionality of vertebral structures. Blockade prevents the progress of this process.

Sometimes this manipulation is used for diagnostic purposes. Some diseases are very difficult to see.

In such cases, the introduction of selective blockade is effective to clarify the diagnosis.

For example, if the pain syndrome in the lumbosacral area is stopped after the injection of anesthetics, then this site is its source.

Benefits

Pros of the paravertebral blockade:

• high efficiency and quick action;
• immediate proximity of the injection to the lesion focus;
• a minimum of side effects;
• with exacerbation of pain, the procedure can be repeated;
• complex action on a problem place (anesthetizing, antispasmodic, decongestant, anti-inflammatory).

Types of paravertebral blockade

Depending on what structures the blockade affects, its types are distinguished:

• tissue- The injection is done in the tissues surrounding the diseased part of the spine;
• conductor- drugs are administered epidurally, perineurally, epidurally, blocking nerve fibers;
• ganglionic- the site of the medication is the nerve plexus;
• receptor- injection into bioactive points of muscle tissues, skin, tendons.

Important!Any blockade should be carried out by an experienced specialist. The physician should know the anatomy well, take into account all contraindications during the manipulation. It is necessary to make the blockade in sterile conditions, before the procedure the patient must give written consent for its conduct.

Indications for conduction

Paravertebral block of the lumbosacral region is necessary for the rapid removal of the pain syndrome with the following diseases:

Typically, blockades are done with degenerative-dystrophic processes in the spinal column. Manipulations are carried out strictly according to the testimony of a specialist. In each case, there will be a treatment scheme and a list of preparations for administration.

In some cases, one injection is enough to permanently get rid of the pain. Sometimes it is necessary to take a course of at least 2 injections with a break of 4-5 days.

In this case, it is not possible to resort to courses of paravertebral blockades more than 4 times a year.

Contraindications and possible complications

Contraindications:

• infection and inflammation on the skin in the area of ​​injection;
• predisposition to bleeding;
• individual intolerance to certain medications;
• heart and liver diseases;
• pregnancy and lactation;
• CNS disorders;
• childhood.

After the blockade, some patients may experience complications:

• bleeding;
• infection in the body through the injection site;
• skin trauma;
• an allergic reaction to drugs or other side effects associated with their administration.

Used medicines

Depending on the number of drugs that are used for manipulation, blockades are:

• 1-component (1 drug);
• 2-component (2 medicines);
• multicomponent (more than 3).

The pain syndrome is treated with a blockade using different groups of drugs.

Anesthetics

They are used both with single-component blockades and with the use of other medications. Acting on nerve fibers, anesthetics "turn off" the pain syndrome, delaying nerve impulses.

Preparations:

• Novocaine- use more often than others. The preparation is produced in the form of a solution with concentration from 5% to 2%. Novocain should begin to function within 2-3 minutes after the blockade. The analgesic effect lasts up to 2 hours.
• Lidocaine- has a rapid anesthetic effect, which lasts for 2-3 hours.
• Merkain- the drug begins to act after 10-20 minutes after administration. The therapeutic effect is longer, compared with Novocaine and Lidocaine (3-5 hours).

The dosage of the drug for administration should be regulated by a physician. Before blockade, a sample should be tested for sensitivity to the drug being administered.

Corticosteroids

Relate to drugs of strong action. Have a pronounced anti-inflammatory, analgesic effect. Quickly remove the swelling in the area of ​​administration.

Hormonal agents are used for intolerable pains that are not stopped by conventional analgesics.

Medications are practically not used on their own, but injected simultaneously with anesthetics to enhance the therapeutic effect and prevent the development of an allergic reaction.

Effective corticosteroids for blockade:

• Hydrocortisone (effective for neural blockades);
• Dexamethasone (suitable for administration in soft tissues and joints);
• Diprospan;
• Kenalog (a drug of prolonged action for blockade of joints).

Other drugs

Medicines can be prescribed as additional funds in a multicomponent blockade. These include:

• vitamins of group B;
• Rumalon;
• Lidase;
• Papain and others.

Techniques for conducting

Since the injection is injected into the spine area, the procedure must be performed by a specialist. Any mistake can cost the patient health.

In most cases, the paravertebral blockade is done by a neurologist or neurosurgeon.

The cabinet for manipulation should have a special sterile equipment.

Blockade of the lumbosacral section is carried out in a certain area of ​​the skin, muscles and other structures. A drug or a mixture of drugs is injected at a specific point where pain is more acute.

Stage 1 of the blockade - preparatory. I need to lie on my stomach. The doctor probes the most painful place.

The skin around the intended injection site should be treated with an antiseptic (iodine or alcohol).

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Then several injections of a thin needle from the right and left side of certain parts of the spinal column in the focus of pain are anesthetized to form a "lemon crust."

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Stage 2 - the procedure of the paravertebral blockade itself. As anesthesia begins to act, take a thick needle, through which the medicine will be administered.

There are 2 methods for implementing the procedure:

• Introduce a 10 cm thick needle filled with medicine, with lateral displacement from the spinous processes directly into the intervertebral space of the affected area of ​​the waist or sacrum. The needle must rest in the process. Then stretch the needle a little and direct it to the transverse process. Each level of the pathological segment should receive a certain dose of the drug. Such points of the paravertebral block can be 3-6.
• The needle is inserted over the spinous process of the damaged segment of the spine. You should feel the gliding while holding the needle on the surface of the appendage. The drug solution is administered continuously. The needle is inserted until it rests against the vertebral arch, then moves to, cm toward the middle of the trunk.

Paravertebral blockade is one of the fastest and most effective methods of eliminating the pain syndrome in vertebral pathologies. Take this manipulation very seriously. Only an experienced specialist can carry out the blockade. If the technique of the procedure is broken or all contraindications are not taken into account, this can lead to irreparable complications.

In more detail about how the paravertebral blockade of the lumbosacral spine is performed with a hernia, find out after watching the following clip:

A source: http://vse-o-spine.com/lechenie/protsedury/paravertebralnaya-blokada.html

Blockade of the lumbar intervertebral hernia

Blockade with a hernia of the lumbar spine sometimes becomes a necessary measure to eliminate the intense pain syndrome. Strongly effective drugs can quickly get rid of pain, but their introduction requires increased caution and attention.

It is often possible to hear the question: if a spinal cord block is performed with a hernia - is it dangerous? And the answer can be unequivocal: modern methods in the implementation of all rules are considered safe for health. However, certain complications are possible, which can be eliminated with timely detection. It is important to strictly adhere to all contraindications and limitations.

The essence of the procedure

In the general case, the therapeutic blockade is a temporary disconnection of the nerve receptors on the site of localization of the pain syndrome.

This effect is achieved by introducing directly into the lesion anesthetic (anesthetic), which for a certain time blocks the transfer of impulses to the brain.

This effect gives time to eliminate the causes of pain.

The main manifestation of the hernia of the spine, especially in advanced stages, is severe pain in the affected vertebral part, which causes immobilization and physical suffering of the sick person.

During such attacks, there is a need to quickly eliminate the pain syndrome, and the action of painkillers of a systemic nature does not give the desired result.

Most often, such phenomena occur in the region of the waist and neck.

The blockade of the intervertebral hernia is designed to solve this problem in the shortest possible time. Depending on the location of the lesion it can be carried out in the cervical, thoracic or lumbosacral spine.

All manipulations should be performed without damaging the vessels and nerve processes.

The method of blockade, the choice of means and its volume depend on the localization of pathology and the nature of the pain syndrome. In order to correctly choose the mode of action, the pain syndrome in hernia of the spine is divided into severity:

• 1 degree: pain occurs with sudden movements and disappears at rest;
• 2 degree: painful sensations subside only in lying position;
• 3 degree: the pain syndrome is permanent and does not depend on the position of the body.

Purpose of procedure

The blockade of the spine is divided into several types according to the method of carrying out and the composition of the injected agent. By injection technology, there are such basic types of procedure:

1. Intralaminar type. When injected, the drug is delivered along the central axis of the vertebral column between the vertebral processes. This method is used most often and allows you to deliver the active substance to the zone located directly near the affected nerve root.
2. Transforominal type. The drug is injected directly into the exit site of the spinal nerve end from the intervertebral foramen. Thus, the injection is carried out directly into the outlet, which requires great accuracy from the doctor.

The duration of any block manipulation is no more than 25-35 minutes, but after the procedure the doctor should check the patient's reaction for at least 2 hours more. When complicating effects appear, urgent measures are taken to eliminate them.

The composition of the injected drug vertebral blockade is divided into the following main types:

1. Novokainovaya blockade with a hernia of the spine. It is carried out with novocaine, has many advantages and is considered the most common type.
2. Epidural block. It is used for a severe pain attack.

In addition to the blockade effected directly on the spinal elements, the technique of paravertebral blockade is common, in which the drug is injected into the near-vertebral zone. The following types of paravertebral block are distinguished:

1. Tissue injection. The injection is made into the soft tissues surrounding the lesion site.
2. Receptor appearance. The composition is introduced into biologically active points, which can be located on the skin, in muscles, joints, ligaments.
3. Conductor blockade. In this case, the effect is performed on nerve fibers by epidural, epidural, paranephalic or perivascular methods.
4. Ganglionic injection. The injection is performed in the nerve plexus.

The blockade of the spine can be carried out by introducing the drug into such zones:

• cervical, thoracic and lumbar spine;
• sacrum;
• sciatic, tibial, occipital and supralateral nerves;
• pear-shaped, suprapular and anterior staircase;
• muscle of the head;
• articular joint;
• posterior branches of spinal nerves;
• epidural and epidural spinal spaces;
• sacroiliac and sacrococcygeal joints.

Pain blockade involves the introduction of potent drugs. Such impacts can not pass completely without a trace, and therefore certain restrictions are imposed on the implementation of the procedure. Blockade is contraindicated in the following circumstances:

• individual hypertrophic sensitivity to the drug;
• pathology of the cardiovascular system;
• renal and hepatic impairment;
• CNS disease;
• infectious lesions in acute phase;
• arterial hypotension;
• epilepsy;
• blood diseases (hemophilia, thrombocytopenia, etc.);
• purulent skin lesions at the site of injection;
• pregnancy and nursing of the baby.

What formulations can be used

To block the pain syndrome in the hernia of the lumbar vertebral column, different drugs can be used.

By structure, they can be divided into one two-and multi-component.

The most widely used are local anesthetics that block the transmission of nerve impulses. Such active substances are allocated:

1. Novocaine. Its concentration in the solution is within -2%, depending on the intensity of pain. Anesthesia manifests itself 3-4 minutes after the administration, and the effect of the composition persists for, h.
2. Lidocaine. It is characterized by a very rapid onset of the effect with a duration of -3 hours.
3. Markain (analog - Bupivacaine). The effect of complete anesthesia occurs quite late (after 12-15 minutes), but its effect persists for 5-6 hours.

In two- and multicomponent formulations, along with anesthetics, hormonal corticosteroids with anti-inflammatory and anti-edematous effects are administered. With severe pain, they can be used alone. The following drugs are used: Hydrocortisone, Dexamethasone, Depo-Medrol, Diprospan, Kenalog.

As additional ingredients, other targeting agents can be used. They allow simultaneously with anesthesia to provide treatment of the underlying disease. In the lumbar region, such means are used:

• vitamins B (most often - B1 and B12);
• ATP;
• Lidase;
• Platyphylline;
• Thrombolizine;
• Rumalon;
• Papain;
• Voltaren.

Possible problems with blockade

The consequences of an analgesic blockade of the lumbar region with a hernia can be quite serious.

Most often, they are associated with the doctor's mistakes during the injection or the wrong choice of the type and dosage of the drug.

Often complications are caused by individual features of the human body and the presence of other pathologies. The human factor can be manifested by such errors:

• accidental damage to internal organs located near the lesion (lungs, pleura, organs of the genitourinary system suffer);
• damage to the shell of the spinal canal, most often when exposed to the sacrum;
• piercing with a needle of vascular plexuses or veins located near the spinal column.

In a number of cases, such complications are noted:

• headache and insufficient breathing when the drug penetrates into the subarachnoid space;
• neurological problems, when the needle passed between the vertebrae and fell directly into the spinal cord;
• reactions of anaphylactic nature in violation of the integrity of blood vessels and getting into them of the injected agent;
• infectious lesions in violation of hygienic rules for the procedure;
• bladder pathology with excessively long exposure to anesthesia;
• allergic reactions of various types with hypertrophied sensitivity.

Patient Reviews

Numerous reviews of people who have experienced the method of analgesic blockade, prove the effectiveness of this method of treatment of hernia of the spine. You can give some of them:

1. Irina from Vladimir: "How I suffered with severe pain in the lower back, how much suffering they brought, and painkillers did not help. We carried out the blockade with the introduction of lidocaine, and a real miracle occurred. The pains disappeared almost immediately. Now I clearly know what to do with spinal hernia attacks. "
2. Nikolai from Novosibirsk: "I went to the gym, where I was actively warming up. Suddenly, so caught in the lower back, that neither bend, nor straighten up does not go - wild pain. What just did not accept, but no use. An experienced doctor arrived in time, who had a Novocaine blockade. Everything, as a hand took off. I address to other sufferers: it is not necessary to test patience, the blockade will help in a few minutes ".
3. Constantine from Novocherkassk: "I always believed that the blockade would help during an acute attack of the hernia of the spine. But one day, for some reason, the usual novocaine injection did not work. The doctor, however, quickly navigated, and introduced Depot-Medrol. As a result, my belief in the miraculous nature of the blockade remained unshakable. The main thing is to choose the right medicine ".

Blockade with a hernia in the lumbar spine can quickly and effectively eliminate intolerable pain. Of course, only this way to cure the disease is impossible.

However, the removal of this severe symptom makes it possible to calmly carry out complex treatment.

Modern drugs have a prolonged effect, which for a long time relieves the suffering.

A source: https://OrtoCure.ru/pozvonochnik/gryzha/blokada-pri-gryzhe-poyasnichnogo-otdela.html