Injections into the chalazion (kenalog, diprospan, dexamethasone)

Knee block: what is it?

The blockade procedure is an injection into the knee joint to quickly relieve pain and restore its mobility.

To provide an analgesic and therapeutic effect, the following medications (or a combination thereof) are used:

• anesthetics (trimeacaine, lidocaine, the least allergenic novocaine) - have a good, but short-lived analgesic effect;
• corticosteroids (prednisolone, Kenalog, diprospan prolonged effect) - have a pronounced anti-inflammatory effect, but with frequent use they increase degenerative processes in the joint;
• chondroprotectors (Fermatron, Alflutop, Ostenil) and hyaluronic acid - for arthrosis, they replenish the lack of joint fluid;
• vitamins (milgamma) - improve tissue nutrition and promote speedy recovery.

Characteristics of Diprospan

This is a solution for injection. 1 ml of solution contains 2 mg of betamethasone disodium phosphate and 5 mg of betamethasone dipropionate. Available in ampoules of 1 ml.

Diprospan is an antiallergic, immunosuppressive and anti-inflammatory agent. Exhibits glucocorticosteroid activity and affects metabolism. The active components inhibit the release of interleukin 1 and 2 from lymphocytes, macrophages and interferon gamma. Reduce the intensity of arachidonic acid metabolism.

Betamethasone sodium phosphate is highly soluble in water and, after parenteral administration into the body, is hydrolyzed and absorbed. This ensures a rapid onset of therapeutic effects on the body. Within 24 hours after administration, it is almost completely eliminated from the body.

Betamethasone dipropionate, on the contrary, is slowly distributed throughout the body and metabolized. This ensures a prolonged effect of the drug - for 10 days.

Subject to breakdown in the liver with the formation of clinically insignificant metabolites. Excreted by the kidneys.

Diprospan is an antiallergic, immunosuppressive and anti-inflammatory agent.

Diprospan is indicated for use in the following cases:

1. Diseases of the musculoskeletal system, soft tissues: rheumatoid arthritis, osteoarthritis, inflammation of the joint capsule, spondyloarthritis, radiculitis, lumbago, fasciitis and some foot diseases.
2. Allergic pathologies, incl. asthma, hay fever, bronchitis, seasonal or permanent rhinitis, allergies to drugs introduced into the body, active reaction to insect bites.
3. Some dermatological pathologies are atopic dermatitis, coin-shaped eczema, neurodermatitis, contact dermatitis, photodermatitis, lichen planus, lupus erythematosus, psoriasis, pemphigus vulgaris.
4. Systemic lupus erythematosus, scleroderma and other connective tissue pathologies.
5. Leukemia (as part of palliative therapy in adults).
6. Adrenal cortex insufficiency (primary and secondary).
7. Diseases requiring constant administration of glucocorticosteroids: malabsorption, colitis, regional ileitis, nephritis and nephrotic syndrome.

Diprospan is contraindicated in the following cases:

• increased sensitivity of the body to betamethasone and other glucocorticosteroid drugs;
• mycoses;
• joint instability;
• arthritis of infectious origin;
• pregnancy and breastfeeding.

This remedy is used with caution when:

• thyroid disease;
• eye pathologies caused by herpes viruses;
• threat of perforation of ulcerative colitis;
• myasthenia gravis;
• thrombotic, thrombocytopenic purpura;
• increase in blood pressure.

Intramuscular, intraarticular, periarticular, and interstitial injections are allowed. Subcutaneous administration of the drug is strictly prohibited (severe allergic reactions develop after subcutaneous administration). The drug is administered intramuscularly deep into the muscle.

Diprospan has the following side effects:

• various disorders of water-salt metabolism (decreased amount of sodium in the blood and increased intensity of potassium excretion);
• chronic heart failure;
• muscle weakness, myopathy;
• ulcerative and necrotic lesions of the mucous membranes of the stomach and intestines;
• inflammation of the pancreas;
• difficult healing of wounds and ulcers;
• excessive sweating;
• the appearance of acne and stretch marks on the skin;
• increased tendency to develop candidiasis (thrush);
• a sharp increase in intracranial pressure;
• frequent mood changes;
• sleep disorders.

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Indications, contraindications

The indication for blockade is severe pain in the following diseases:

• non-infectious forms of arthritis - rheumatoid, psoriatic, reactive, post-traumatic/postoperative serous, ankylosing spondylitis;
• synovitis as a consequence of osteoarthritis;
• limited inflammation of periarticular structures (without arthritis) - tenosynovitis, bursitis, periarthritis.

Since corticosteroids activate slow-onset degenerative processes, knee blockade is contraindicated in cases of severe destruction of bone tissue (chronic deforming arthritis).

For deforming osteoarthritis, only periatricular administration of drugs is allowed. It makes no sense to do new blockades if the previous 2-3 procedures did not bring the desired result.

Compound similarities

The main similarity of these drugs is that each of them is a synthetic glucocorticosteroid. This allows them to be used in a large number of inflammatory pathologies and in the treatment of allergic reactions.

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The similarity in composition and belonging of these drugs to the same pharmacological group determines the specificity of drug interactions:

• they cannot be combined with anticoagulants;
• accelerate the removal of Acetylsalicylic acid from the body;
• increase the toxicity of cardiac glycosides;
• increase the toxic effect on the liver of Paracetamol;
• slow down the absorption of antacid drugs.

Result

The effectiveness and speed of onset of the analgesic effect depends on the chosen drug and its dosage.

Diprospan is an effective and relatively safe drug for blocking the knee joint.

Its dosage is selected individually and does not exceed 1 ml.

The analgesic effect occurs within 2-4 hours.

The fastest-acting drug is Kenalog (pain relief after 1 hour), but the high risk of atrophy of the subcutaneous layers limits its use.

The duration of pain relief lasts 1 month.

Additional information about the procedure.

It should be noted that the frequency of intra-articular blockades is determined depending on the type of joint, as well as the stage of the pathology that the patient wants to get rid of. This process should not be carried out on large joint capsules more than once every 2-3 months. This type of joint includes the knee and hip. Other joints may be subject to blockade no more than once every 2-4 weeks. If the proposed interval is not observed between injections, the process of destruction of connective tissue, namely cartilage, may begin due to the administered glucosteroids.

In some cases, after intra-articular blockade of the knee or hip joint, the patient does not feel any improvement. Then it is necessary to suspend planned procedures, and then immediately re-diagnose, since the reason for the lack of a positive treatment effect may be an erroneously determined diagnosis.

Patient reviews of Kenalog and Diprospan

Irina, 50 years old, Moscow: “I have been suffering from gout for a long time. Sometimes joint pain is unbearable and does not go away with ordinary painkillers. In such cases I use Diprospan. Injections quickly relieve the condition, relieve pain, stiffness, redness and fever. There were no side effects, my health improved within a few days, the pain went away, and joint movements resumed.”

Svetlana, 35 years old, Nizhny Novgorod: “For several years I have been suffering from allergic rhinitis, which is especially aggravated during flowering of plants. To get rid of allergic manifestations, I take Kenalog intramuscularly. It has a quick effect and relieves allergies within 15 minutes. I did not observe any adverse reactions from the treatment. These injections are better than others in relieving allergies. At the same time, the shortness of breath went away, the sense of smell returned to normal, and the constant irritability disappeared.”

Oleg, 55 years old, Ob: “I use Diprospan to treat inflammation of the joints. I use these injections for pain and stiffness, which are especially aggravated by changing weather or changing seasons. In just 15-20 minutes the pain goes away and I can bend my knees normally. I did not observe any undesirable effects from treatment with Diprospan. The medicine can quickly put you back on your feet when the pain appears suddenly.”

List of sources used

1. Fedorov S.N., Yartseva N.S., Ismankulov A.O. Eye diseases: A textbook for medical students. – 2nd ed., revised. and additional – M.: 2005. – 440 p. 2. Trubilin V.N., Polunina E.G., Angelova D.V., Evstigneeva Yu.V., Chinenova K.V. The use of antibacterial eye ointments in the treatment of acute and chronic diseases of the eyelids and conjunctiva. Ophthalmology. 2019;16(1):31–37 3. Lee JW, Yau GS, Wong MY, Yuen CY. A comparison of intralesional triamcinolone acetonide injection for primary chalazion in children and adults. ScientificWorldJournal. 2014;2014:413729 4. Dua HS, Nilawar DV. Nonsurgical therapy of chalazion. Am J Ophthalmol. 1982 Sep;94(3):424-5. 5. Li RT, Lai JS, Ng JS, Law RW, Lau EM, Lam DS. Efficacy of lignocaine 2% gel in chalazion surgery. Br J Ophthalmol. 2003 Feb;87(2):157-9 6. Aycinena AR, Achiron A, Paul M, Burgansky-Eliash Z. Incision and Curettage Versus Steroid Injection for the Treatment of Chalazia: A Meta-Analysis. Ophthalmic Plast Reconstr Surg. 2021 May-Jun;32(3):220-4.

Types of blockade in medicine

• local ones are performed directly at the site of the lesion. They are also produced around affected areas or under them. Local blockades are divided into the periarticular type, in which the impact is on the periarticular tissues, as well as on the perineural ones. The last subtype involves performing a blockade in the channels through which the nerves pass;
• segmental blockades have an indirect effect through crossed nerve tissues. Why do they blockade? More on this later.

Medical blockades. Principle of use

Based on the principle of application, blockades in medicine are divided into therapeutic and diagnostic. What is the difference?

• therapeutic blockade is a safe technique that is necessary for the treatment of syndromes and pathologies that are accompanied by severe pain associated with neurological, rheumatoid and postoperative problems;
• Diagnostic blockades give the doctor the opportunity to quickly and accurately identify certain causes of pain in order to make a diagnosis. In some situations, painful sensations may be the result of some kind of inflammation or irritation of structures with pain receptors. After introducing the medicine into the pain generator, all unpleasant sensations disappear for a while, which gives doctors the opportunity to determine a more accurate diagnosis. The effectiveness, as well as the course of treatment, directly depends on proper diagnosis. Not everyone knows what a blockade is in medicine.

Which is better - Kenalog or Diprospan?

Although these drugs have similar characteristics, they have different uses.

Thus, Kenalog is recommended for a large number of allergic reactions. It cannot be replaced with Diprospan, because the latter does not have such pronounced antiallergic activity. Kenalog justifies its use for psoriasis, incorrect functioning of the adrenal glands and oncological pathologies of the prostate gland. It is injected inside the joints to block and quickly relieve pain.

The intended use of Diprospan is inflammatory lesions. It is better for arthritis, bursitis, osteoarthritis. Kenalog will not cope with these diseases. In some cases, Diprospan will be effective for certain allergic pathologies, bronchitis, and rhinitis. The advisability of prescribing Diprospan or Kenalog for these diseases is determined by the doctor after a thorough examination of the patient.

Both drugs are excellent for treating pain and inflammation of a non-infectious nature, and allergies.

Blockades according to Vishnevsky

The basics of blockades in medicine were developed and proposed by Vishnevsky. The main goal was to interrupt impulses in situations of pleuropulmonary shock, which appears due to wounds in the thoracic region. Thus, the author of the blockade came to some conclusions, on the basis of which various categories of blockades were developed:

• Inflammatory processes that differ in their etiology obey the same laws, especially at the developmental stage;
• the formation of inflammations can be slowed down or stopped if they are located in a state of serous impregnation of nerve tissue;
• abscess types of inflammation begin to fester, and hidden types begin to appear;
• restoration of the vascular wall occurs if its physiology has been disrupted as a result of a pathological process associated with impaired tone, and, in addition, the permeability of small vessels.

According to Vishnevsky, varieties of blockades were developed, thanks to the use of which medicine has made significant strides forward. It is important to note that the procedure should be performed only by highly qualified doctors, since if mistakes are made, complications may arise in patients. It is important to note that there is not only a blockade for the back. Injections of drugs are also given to other areas of the body.

• Cervical blockade - indications for this type of blockade include injuries to the chest and head. It is used for pleuropulmonary shock. As part of the complications, it is reported that in one case out of a hundred, in situations of doctor incompetence or due to the peculiarities of the procedure, the needle may enter the carotid artery;
• Short blockade - indications for this blockade are the presence of processes of inflammation of the tissue or skin in the initial stages. Examples include the appearance of carbuncles, boils and mastitis. This type of blockade does not cause any complications;
• Perinephric blockade - it is done for intestinal obstruction in the acute stages, as well as for infiltration, intestinal paresis, shock and renal colic. The main complications are punctures of the kidneys or intestines;
• Presacral blockade - this blockade is performed as part of surgical interventions performed on the intestine. It is also performed in the presence of inflammation in the pelvic area, as well as in cases of pinched hemorrhoids. This type of blockade does not cause any complications;
• Case blockade - it is caused by the presence of inflammatory processes along with snake bites, frostbite or burns of the extremities. This blockade does not cause complications;
• Intrapelvic blockade - it is performed in the presence of fractures or damage to the pelvic bone. If the procedure is carried out correctly, it does not cause any complications;
• Intercostal blockade - the intercostal type of blockade is most often used in neurology or traumatology. In addition, it is suitable for neuralgia, rib fractures or thoracotomy. As part of possible complications, injury to the arteries, as well as punctures of the pleura, cannot be excluded;
• Local intravenous blockade - it is used for arthrosis, tendovaginitis, a purulent disease that spreads to the limbs. This blockade does not cause complications;
• Paravertebral blockade - it is used in the presence of chest injuries, and also in case of rib fractures. This blockade also does not cause complications.

So, now let’s find out which drugs in medicine are considered the most popular in the implementation of the blockade. What exactly should I use?

Paravertebral and vertebral blockade

The segmental type of medical blockade, in turn, is divided into paravertebral, as well as vertebral:

• paravertebral blockade is a qualified procedure that is performed to relieve or dull pain. It is used mainly against the background of back pain. From the technical side, a spinal block is the introduction of a special mixture into the affected area by a medical specialist. Simply put, this is, first of all, an ordinary injection that is performed near the spine. With its help, it is possible to turn off reflexes for a while, significantly reducing swelling and improving the nutrition of the nerve roots. Thus, paravertebral blockades are necessary for pain relief along with preventive measures to detect concomitant pathologies. In situations where a chronic type of pain syndrome occurs, muscle spasms cannot be ruled out, which ultimately can cause their defective functioning;
• Vertebral spinal blockade is one of the treatment options for back diseases. As part of therapy, it allows you to get rid of uncomfortable and, in addition, painful sensations, mainly in the lumbar region, and as a diagnostic method, it makes it possible to examine the picture of diseases associated with the spine in more detail.

Analogues of Kenalog

Among Kenalog analogs, the following are the most popular medications:

Kenalog is quite toxic and doctors justify its use only in extreme cases when conservative treatment has not had the desired effect.

This factor also affects the high probability of the need to select an analogue.

Reviews from doctors

Nikolai Pavlovich, therapist, 53 years old, Moscow: “To eliminate allergic reactions, I prescribe Kenalog to my patients. It is distinguished by its rapid action: within 15 minutes there is a decrease in the inflammatory process, swelling and redness. This remedy is especially suitable for exacerbations of seasonal allergies. When the drug is prescribed correctly and all precautions are taken, the likelihood of side effects is reduced to almost zero. The patients' health status is improving rapidly."

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Irina Aleksandrovna, therapist, 45 years old, Veliky Novgorod: “I use Diprospan to quickly relieve pain from gout, rheumatism, and inflammatory diseases of the joint capsule. The analgesic effect of this drug begins approximately 10-15 minutes after injection of the drug. To provide the necessary effect, 1 ampoule of Diprospan is enough. No side effects were observed, all patients carefully adhered to the regimen. The patients are in good health."

Differences between Kenalog and Diprospan

Diprospan is produced by a Swiss pharmaceutical company. The product is used to treat muscle and bone pathologies, systemic diseases, skin and subcutaneous tissue. It is an excellent drug for the treatment of joint diseases. It also has a pronounced analgesic effect: the patient notes a rapid decrease in pain intensity.

Kenalog is produced by a Slovenian pharmaceutical corporation. Active in a large number of allergic pathologies, incl. of medicinal origin. The effect develops after just a few injections.

The effectiveness of Diprospan is higher because it eliminates the acute condition. According to foreign pharmacists, this drug has a large number of side effects.