Pharmacology of therapeutic blockades - anesthetics, prolongators, etc.

Most vertebrologists now agree that acute pain syndrome that occurs in the spine or lower extremities should be eliminated.

If this is not done in a timely manner, a chronic painful symptom complex will provoke the formation of psychogenic disorders in the body, and this, accordingly, can lead to aggravation of therapeutic manipulations.

In cases where rapid relief with medicinal analgesics by parenteral administration is not possible, a blockade of the lumbar and sacral spine is used.

What are blockades

Therapeutic blockades are the relief of acute or chronic pain and spasms. It is performed by injection into the area where the nerve trunks and plexuses pass. Severe pain causes physical and psychological suffering, incapacitates the patient and can cause disability. Depression that occurs against this background often leads to suicide attempts.

Therapeutic blockades quickly relieve acute pain. After some time, swelling, inflammation, spasm of muscles and blood vessels decrease. This leads to a lasting improvement in the condition. At the 100med medical center, blockades are performed by neurologists and anesthesiologists. Several groups of drugs are used for the procedure:

• local anesthetics;
• corticosteroid hormones;
• chondroprotectors.

The effect of drug administration lasts from several days to several weeks. After the medicine stops working, the pain may return. However, its severity will be less by about 50%.

During the procedure, the patient may feel some discomfort associated with the injection. However, the discomfort quickly passes. There is no need to be afraid of blockades, as this method is one of the safest. Our specialists strictly follow all the rules for performing the procedure, as well as asepsis and antiseptics. This guarantees the effectiveness and safety of blockades in our clinic.

Kinds

Blockades differ in the type of drugs used, the area and depth of their administration. The doctor chooses which injections will bring maximum effect individually, based on the patient’s diagnosis and observed symptoms.

Injections are performed in any part of the back:

• cervical – help eliminate pain in the neck, head, shoulder girdle, arms and throughout the entire spine;
• chest – eliminates pain in the arms, chest and entire torso;
• lumbar – eliminates lower back pain and is used for diagnostics;
• coccyx area – helps eliminate pain in the lumbosacral spine.

A blockade in the area of ​​the cervical vertebrae leads to the elimination of pain in the entire back, but requires high qualifications from a specialist.

Injections can be carried out not only into soft tissues, but also into tendons, as well as into the points of passage of nerve fibers or specific biologically active points, etc. In this way, a solution of lidocaine or novocaine, which has exclusively analgesic properties, can be administered.

There are also therapeutic blockades. They involve the administration of a mixture of anesthetic and corticosteroids. This allows you to additionally obtain an anti-inflammatory effect. They help to avoid the development of side effects characteristic of systemic corticosteroids and achieve a pronounced anti-inflammatory effect.

In addition to anesthetics, the solution may contain B vitamins. They are used to normalize the transmission of nerve impulses. Also, a component of the therapeutic “cocktail” can be chondroprotectors, which contribute to the active saturation of cartilage tissue with its structural elements and increase elasticity.

But the main difference between back blocks lies in the method of their implementation. Therefore, they distinguish:

• epidural;
• paravertebral;
• intercostal.

Spinal epidural block

Epidural is a blockade in which drugs are injected into the gap between the periosteum of the spinal canal and the dura mater. It is most effective for lower back pain and is often used as an anesthetic for a number of surgeries.

To perform it, the patient lies on one side or another, less often on the stomach. The essence of the procedure is as follows:

• the lumbar area is treated with an antiseptic solution;
• Local tissue anesthesia is performed in the projection of the lumbar vertebrae;
• anatomical landmarks are determined by the protruding spinous processes;
• the needle is inserted strictly between the third and fourth or fourth and fifth lumbar vertebrae, piercing all the ligaments and resting on the hard shell;
• the resistance of the boundaries of the epidural space is carefully overcome and a mixture of selected drugs is slowly introduced;
• the needle is removed and the insertion site is covered with a sterile bandage.

An epidural block may be accompanied by a sharp change in blood pressure, either upward or downward. Therefore, patients may be pre-administered caffeine or ephedrine depending on their typical operating pressure level.

The effect of the manipulation is observed immediately and lasts quite a long time. When carried out in a timely manner, an epidural block allows you to completely break the chain of transmission of pain impulses.

Paravertebral blockades

Paravertebral blockade is a procedure during which a solution of drugs is injected into the area where a specific nerve branch passes in the area, the so-called paravertebral line. It passes at the level of the transverse vertebral processes.

The action of the anesthetic leads to the switching off of the nerve fiber, which effectively eliminates pain in the organs or areas of the body innervated by it. Since the nerves responsible for the functioning of different organs and parts of the body penetrate soft tissues at different depths, there are 4 types of paravertebral blockades:

• fabric;
• receptor;
• conductive;
• ganglionic.

During the procedure, there is no intervention in the spinal membranes, which is its undoubted advantage and makes it more popular than the epidural block. Injections of drugs into the area of ​​the paravertebral line are also used to diagnose neuralgic disorders, since they give results exclusively for pain caused by damage to the corresponding nerve root.

In case of pain in the lumbar region, manipulation is carried out from a lying position on the stomach. The doctor palpates the area of ​​greatest pain and, after treating the skin with an antiseptic and intradermal injection of novocaine, inserts a syringe needle at a distance of 3–4 cm from the spinous processes to perform a blockade.

The needle is slowly advanced deep into the soft tissues, gradually introducing the solution in small doses, until it rests on the transverse process of the vertebra. From this point on, the direction of needle advancement is changed so that it can go around the vertebra along its upper or lower border. Thus, it is immersed another 2 cm deep, and the remaining solution is slowly introduced. In total, the needle during paravertebral blockade penetrates to a depth of 5–6 cm.

In certain cases, it is necessary to perform bilateral paravertebral blockades and use from 3 to 6 points.

If it is necessary to numb the neck or thoracic spine, the anesthetic is injected on both sides, 2 cm from the vertebra provoking the pain syndrome. The needle is immersed 3–3.5 cm into soft tissue.

After the procedure, the patient should remain lying down and avoid changing body position for 2 hours.

Intercostal blocks

The introduction of anesthetic solutions into the intercostal space is required if the nerves in this area are damaged. Drugs can be injected into the area of ​​the posterior, anterior, lateral parts of the ribs, as well as along the parasternal line.

The procedure is performed from a lying position on the healthy side. Initially, the skin must be treated with an antiseptic solution and prepared by local anesthesia with a novocaine solution. Then a needle is inserted perpendicular to the lower edge of the desired rib to carry out the blockade. After reaching its edge, the direction of its insertion is changed, due to which it is immersed in the soft tissue under the rib. During the procedure, control aspiration is periodically performed to ensure that there is no damage to the blood vessels.

Nerve block

A nerve block is a treatment in which a local anesthetic is injected into the soft tissue where the peripheral nerve passes. The procedure allows you to relieve pain, spasm of muscles and blood vessels, swelling and inflammation. Indications for manipulation:

• neuritis;
• neuralgia;
• tunnel syndrome;
• muscular-tonic syndrome;
• diseases of the spine;
• pain after injury or surgery;
• chronic pain syndrome;
• oncological diseases.

Nerve blocks do not require special preparation. After a thorough examination and examination of the patient, the doctor determines the injection site and treats the skin with an antiseptic. An injection of pain medication is given into the soft tissue. After a few minutes, numbness, warmth and a feeling of heaviness appear in this place. The course of injections (up to 3 sessions) can be repeated every year.

Indications

Any severe pain must certainly be quickly relieved in order to avoid the development of psychological problems and the formation of a persistent focus of excitation in the cerebral cortex, which will negatively affect the effectiveness of the therapy. If severe pain persists for a long time, even after it has subsided, any influence can provoke activation of the formed pain focus of the brain and provoke a new attack, which is very difficult to treat with conservative methods.

Therefore, if indicated, it is important to perform spinal blockades in a timely manner. The procedure is used to relieve pain caused by:

• inflammation of skeletal muscles;
• protrusions and herniations of intervertebral discs;
• radiculitis;
• ankylosing spondylitis;
• osteochondrosis;
• neuritis;
• neuralgia;
• spondyloarthrosis.

It is recommended to do spinal blocks no more than four times a year. But in some situations they are performed ten times every 2–3 days.

It can be used for diagnostic purposes. If after its implementation the pain is eliminated or at least significantly reduced, this eloquently indicates its neurological nature. If there are no positive changes after injections, a more thorough diagnosis of the patient’s condition should be carried out to determine the cause of the development of pain.

Joint blockade

Joint blockade is a method of introducing a drug into the joint cavity or adjacent soft tissues (articular capsule). The method not only relieves pain, but eliminates inflammation, relieves muscle and vascular spasm, and restores range of motion in the joint. The procedure is indicated for the following diseases:

• arthritis of joints of various sizes;
• arthrosis;
• arthralgia;
• synovitis;
• bursitis;
• tendovaginitis;
• periarthritis;
• facet syndrome;
• Reiter's disease;
• Bekhterev's disease.

The injection is performed without additional preparation after a thorough examination. The patient is seated or laid on a couch and the skin over the joint is treated. The injection is made into the cavity of the joint capsule, into the area of ​​the periarticular ligaments or bursa. The effect occurs within a few minutes and lasts up to 3 weeks. The duration of the course depends on the severity of the lesion and can be up to 15 procedures.

Contraindications and complications

Even with very severe pain, a back block cannot always be performed. Contraindications for its implementation are:

• conditions accompanied by blood clotting disorders;
• pregnancy and breastfeeding;
• severe bradycardia, hypotension;
• myasthenia gravis;
• severe renal or liver failure;
• mental disorders;
• epilepsy;
• hypersensitivity to novocaine and lidocaine;
• serious pathologies of the heart and blood vessels;
• acute infectious diseases.

If the technique for performing a spinal block is violated, an inflammatory process may develop and the integrity of the hard shell of the spinal cord may be disrupted, which can lead to a sharp decrease in intracranial pressure. There is also a risk of damage to a blood vessel, which will result in the formation of a large hematoma and numbness of the corresponding part of the body.

Celiac plexus block

With this type of blockade, the medicine is injected into the solar plexus area. The injection is done under the control of an X-ray machine or ultrasound.

The procedure is effective for:

• chronic pancreatitis, pancreatic necrosis;
• abdominal adhesions;
• Crohn's disease;
• tumors of the abdominal organs;
• ineffectiveness of painkillers.

You should prepare for the blockade in advance. A few days before the procedure, the doctor at our clinic recommends stopping taking anticoagulants and diuretics and adjusting the dose of glucose-lowering medications. The patient is placed on his stomach with a bolster or pillow. First, the doctor anesthetizes the soft tissue at the injection site. Then, under X-ray control, a special long needle is inserted. Through it, a local anesthetic or a drug that destroys nerve cells is supplied to the solar plexus. The patient feels warmth in the abdomen and a decrease in pain. After the procedure, observation is required in our hospital for 24 hours.

RADIO FREQUENCY DENERVATION OF SPINAL JOINTS

In cases where the facet joints are changed and surrounded by bone growths (osteophytes), the most suitable minimally invasive surgical method for permanent relief from pain is denervation. Various methods of influencing the own nerve of the joint are used - mechanical, thermal destruction. The most advanced technique that provides minimal damage with maximum efficiency and predictability is radio frequency.

With radiofrequency denervation, thermocoagulation of tissue occurs under the influence of ultra-high frequency electric current. Special needles are applied to the nerves of the diseased joint and an electric current is passed, causing the tissue to heat up to 70 degrees. The nerves are actually cauterized, blocking the passage of pain impulses. At the Yauza Clinical Hospital, denervation of vertebral joints is carried out using a Stryker radiofrequency generator.

The method can be applied in all cases except those when the spinal canal is narrowed or the joint is severely deformed. It is used to treat elderly and even elderly patients. There are practically no complications observed, the duration of pain relief is more than a year.

Paravertebral blockade

Paravertebral blockade is performed to reduce pain in the spine. The effect is achieved by blocking the ganglia or spinal nerves on one or both sides. Indications for this are:

• osteochondrosis;
• radiculitis, lumbago;
• neuralgia;
• myositis;
• hernias and protrusions of intervertebral discs;
• spinal injuries.

To carry out the manipulation, the patient is placed on a flat couch. Local soft tissue anesthesia is first performed. The medicine is injected into the segment of the spine where the pain is felt the most. The injection is given on one or both sides depending on the patient’s condition.

Possible risks with spinal blockade

In some medical conditions, spinal blockade for low back pain is contraindicated. The specialist may decide that it is impossible to perform the procedure if:

• Impaired blood clotting. If the patient is predisposed to severe blood loss or is undergoing anticoagulant treatment, a spinal injection can be dangerous. In this case, the doctor recommends that the patient stop taking Aspirin and Ibuprofen 5 days before the blockade, since they affect the ability of the blood to clot.
• Local or systemic infection. This can significantly increase the risk of transmission of infection to the spinal column, which leads to the development of meningitis. For this reason, the patient is obliged to notify the doctor about the presence of infected wounds, boils or rashes on any part of the skin. Spinal block for low back pain is an elective procedure offered to people who do not have life-threatening conditions. A patient with an unstable health condition must first cure the pathology before injections are prescribed.

Epidural block

An epidural block is the injection of medication into the space between the dura mater and the periosteum of the spinal canal. Depending on the injection site, caudal, translumbar, and transforaminal blockades are distinguished. A good effect of blockades is observed when:

• damage to the radicular nerves;
• periduritis;
• intervertebral hernias;
• spondylolisthesis;
• narrowing of the spinal canal;
• back pain after injury or surgery.

The procedure must be carried out on an empty stomach. The patient is placed on a couch, and the doctor applies local anesthesia to the desired area. Then, under the control of an X-ray machine, a needle is inserted through which the medicine is administered. When performed correctly, the patient feels a slight burst in the back.

Possible dangers of an epidural injection

The doctor usually recommends not doing an epidural block when the patient has problems with the epidural space in the spine. Such deviations can be congenital or acquired during surgical intervention in the spinal column, after which scars are formed.

In addition, this procedure is contraindicated in case of infection. When Cortisone is administered, the body becomes unable to fight infection. You should also not get an epidural injection if you have been diagnosed with diabetes or congestive heart failure.

Content

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Pain levels

0 — 3

Mild pain

- does not interfere with everyday activities, but you can adapt to the pain.

4-6

Moderate pain

- prevents you from doing business, prevents you from concentrating, the patient remains independent

7-8

Strong pain

- it is impossible to carry out daily activities, it is difficult to think about anything other than pain, the patient cannot function independently

9-10

Unbearable pain

- requires urgent care, bed rest, disables the patient

PROGRESS OF MINIMALLY INVASIVE OPERATIONS FOR FACET JOINT SYNDROME

• For visual control of operations on spinal joints, the Clinical Hospital on Yauza uses a C-arm intraoperative control complex manufactured by Philips.
• Both facetplasty and facet joint denervation are virtually outpatient procedures. They last less than an hour and do not require hospitalization.
• Anesthesia is used both local and general. The latter is necessary for immobilization and ensuring the patient's immobility. This requires precision manipulation.
• The operation is usually performed at several levels (segments), often on both sides.
• The postoperative period is up to 2 days. Of these, 1-2 hours of bed rest, then, on the same day, the patient can return home, and after a couple of days - to their normal lifestyle. True, you should not drive immediately after surgery, and elderly patients should benefit from the help of an accompanying person on the way home. Sometimes it is recommended to wear a semi-rigid corset for a week.

Using modern diagnostic equipment, specialists from the Yauza Clinical Hospital will quickly and accurately determine the cause of back pain and carry out adequate, gentle surgical intervention that will relieve pain for a long time.

You can make an appointment with specialists at the Center for Vertebrology and Endoscopic Spine Surgery at the Yauza Clinical Hospital using a special form on the website or by calling the phone number indicated on this page.

Prices for drug blockades