Spinal block - instant relief from back pain

September 24, 2019

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3.7 out of 5

Spinal block is an injection of an anesthetic into strictly defined points located along the spinal column. Often it is not a method of treating an existing disease and does not have any therapeutic effect, but it can quickly relieve the pain it causes. Although there are therapeutic blockades that involve the administration of corticosteroids.

The procedure is performed exclusively in neurosurgical or traumatology medical institutions by qualified medical personnel. No nurse or doctor who has not undergone special training has the right to perform a spinal block, as this is fraught with serious complications and loss of the ability to move.

With “SL Clinic” you no longer need to look for where to perform a back block. By contacting us, you won’t have to wait long in line to relieve a severe attack of pain. Highly qualified specialists of “SL Clinic” will immediately perform all the necessary manipulations with strict adherence to all the subtleties of the blockade injection technique. The price of a spinal block is indicated in the price list and remains consistently affordable for a wide range of people.

Mechanism of action

When pathological changes occur in the spine, the spinal nerves are pinched, which provokes severe pain. Depending on which nerve is pinched, the pain can radiate to the neck, shoulders, buttocks, hips, etc. If it becomes unbearable, the only way to help the person is to perform a blockade.

Due to the targeted administration of the anesthetic, the conduction of impulses along the nerve fibers is temporarily blocked. This leads to the elimination or at least a significant reduction in pain intensity within a couple of minutes. Therefore, the patient can almost immediately return to abandoned activities and move fully.

If the manipulation is performed correctly, there are no negative consequences, which allows you to repeat it as many times as required. An additional advantage is the presence in the injected solution, in addition to the anesthetic, of anti-inflammatory substances. They contribute to the rapid elimination of the inflammatory process in the affected segment of the spine and increase the effectiveness of conservative therapy.

The procedure is carried out exclusively under completely sterile conditions (usually in an operating room or dressing room). This is extremely important, since when viruses or bacteria penetrate the spinal cord, life-threatening complications can develop: meningitis, encephalitis, myelitis.

In the first few days after the manipulation, there may be undesirable consequences in the form of numbness of a part of the body. This does not require correction and goes away on its own in a few days.

What is a herniated disc block?

A spinal block is a kind of “switching off” pain and the mechanisms that cause it. The pain disappears, and the person can freely undergo treatment. The important thing is that the blockade itself is not a method of therapy; it does not relieve a person of a hernia or its other symptoms. This is only a temporary measure that will make the patient’s life easier.

The effect of the blockade is not eternal - it lasts about a month, and if necessary, the procedure is repeated. It happens that the pain still does not go away, its manifestations only decrease - in this case, the blockade is repeated within three days. This is not harmful to the body, because all necessary drugs are selected depending on its sensitivity to certain substances, and the administered doses are safe for human health.

Blocking an intervertebral hernia will allow the patient to undergo effective treatment without experiencing severe pain

Thanks to anesthesia of the damaged area, the patient can engage in special therapeutic exercises without harm or discomfort, take medications and live normally without experiencing any restrictions. In this case, the recovery process will go much faster, because the person will be able to direct all his energy to treatment.

This procedure also has diagnostic value. It happens that even a specialist is not able to identify the cause of the pain. If, after introducing a blockade into the affected area, the pain has decreased or disappeared, then it can be said that the patient has an intervertebral hernia. If this does not happen, then you should look for another reason.

Indications

Medical research proves that any acute pain in the back, especially the lower back and sacrum, should be quickly relieved. Otherwise, they can provoke the development of psychological disorders, which will worsen the effectiveness of the treatment.

Also, with a long course of the disease, a persistent focus of excitation can form in the cerebral cortex. Any additional irritation can cause its activation and the development of a new attack. In such situations, it is very difficult to improve the patient's condition using conservative methods. Therefore, it is much better to prevent the formation of a focus of excitation in the cerebral cortex. If conventional means do not help eliminate pain, a spinal block is used.

The method is intended to relieve pain caused by:

• intervertebral hernias;
• protrusion of intervertebral discs;
• myositis;
• radiculitis;
• neuritis;
• ankylosing spondylitis;
• osteochondrosis;
• spondyloarthrosis;
• intercostal neuralgia;
• trigeminal neuralgia;
• neuralgia of the spinal nerves.

It is worth giving a blockade injection no more than 4 times a year. Although in certain cases, patients are prescribed a course of such injections, consisting of 10 or more procedures. Between them there is a break of 2-3 days.

The method is also often used to diagnose a number of diseases. The effectiveness of the blockade for pain indicates the neurological causes of its occurrence. Otherwise, you should look for another source of pain.

Indications for spinal blockade for hernia

The main indication for blockade of a herniated disc is pain, which can intensify with physical activity and be accompanied by other symptoms. Symptoms depend on the area affected. Common ones include:

• stiffness of the vertebrae, stiffness in movements;
• loss of sensitivity, numbness of the limbs;
• muscle weakness;
• lumbago radiating to different parts of the body.

Any acute pain that is not relieved by drug therapy must be eliminated as quickly as possible using a block in the back for a hernia. The number of injection procedures is determined by the doctor. The break between procedures is 2-4 days.

You can do several courses of blockades per year

During the period of the spinal blockade, the doctor prescribes the main treatment: physiotherapeutic procedures, medications and other methods. The injection reduces not only pain, but also inflammation, helps relieve muscle spasms, and therefore increases the effectiveness of conservative therapy.

Often, a blockade of a spinal hernia is prescribed to conduct a full diagnosis of patients who experience such severe pain that they cannot even stand, sit or lie. During the period of anesthesia, the doctor can conduct an examination to determine the cause of the pain.

Using a blockade, you can treat a hernia of any part of the spine.

Cervical spine

The cervical spine is the most mobile part of the spinal column, so a hernia in it is not uncommon. He is responsible for the work of the neck, shoulders and arms. Therefore, the first signs of a hernia concern the upper body.

The most vulnerable area is the 7th cervical vertebra.

Indications for vertebral blockade:

• severe pain in the neck, back of the head, shoulder girdle;
• weakness in the arms;
• numbness of the upper extremities;
• frequent headaches, migraines, dizziness;
• a feeling of tightness in the cervical region: inability to turn your head to the side or tilt forward, raise your arm;
• pre-fainting condition associated with pinched nerve fibers and blood vessels.

You can learn more about performing a cervical spine block and its results from a neurologist during a personal appointment.

Kazieva Aminat Ziyavovna

Neurologist

Rostov State Medical University

Experience since 2012

Thoracic department

Indications for blockade of the thoracic spine:

• back pain in the thoracic region, between the shoulder blades;
• weakness and numbness of the limbs;
• stiffness, problems with turning the body;
• pain in the chest, similar to heart pain;
• Shootings in the chest.

A hernia in the thoracic spine is rare.

Symptoms of a herniated thoracic spine resemble heart disease

Lumbar

Blockade for a lumbar hernia is one of the most popular procedures, since pathology occurs most often in this area of ​​the spinal column.

Indications for anesthetic injections:

• pain in the lumbar region, radiating to the buttock, leg;
• lumbago in the lumbar region when bending, straightening or turning the body, or physical activity;
• anococcygeal pain syndrome – pain of varying intensity in the coccyx area;
• pinching of the sciatic nerve;
• numbness in the legs, tingling in the fingers;
• movement disorders, spinal stiffness.

Signs depend on the location of the damage, the size of the protrusion and the involvement of spinal structures and facet joints.

There are 3 types of blockades of the lumbosacral spine, depending on the location of the formation of the intervertebral hernia:

• lumbar region – lumbar region, vertebrae L1-L5;
• sacral region – sacral zone, S1-S5;
• coccygeal region - coccyx area, Co1-Co4.

The blockade technique depends on the location of the pain, but paravertebral manipulation is more often used. Mostly hernias form in the L1-L5 zone, that is, in the lumbar region.

Lumbar blockade reduces pain by reducing inflammation and swelling of the nerve root, helps remove spasm of the back muscles, and restores mobility of the lower body.

Kinds

There are quite a few types of blockades. Depending on the nature of the observed clinical picture, drug solutions can be injected into soft tissues, certain biologically active points, tendons, and into the area of ​​passage of nerve fibers or their plexuses. They can be performed on any part of the back, but only a doctor can choose the right type of pain relief. For example, targeted injections into the area of ​​the C1-C7 vertebrae of the cervical spine can eliminate pain in the entire back.

1. Cervical. The drug is injected into the vertebrae of the cervical spine. It makes it possible to completely eliminate pain in the neck, arms and head, as well as throughout the entire spine.
2. Chest. It involves injection of a drug solution at the level of the thoracic spine, which helps to numb the arms, chest and torso muscles, as well as internal organs.
3. Thoraco-lumbar. Helps eliminate pain in the lower back, legs and eliminates discomfort in the intestines.
4. Lumbar – relieves pain in the lumbar region. Can be prescribed by a neurologist or vertebrologist for diagnostic purposes.
5. Coccygeal - designed to eliminate pain in the lumbosacral spine.

There are medicinal, lidocaine and novocaine blockades. The first involves the introduction, in addition to anesthetics, of additional solutions of corticosteroids that have pronounced anti-inflammatory properties. They are considered a fairly effective method of treating pain and other manifestations of neurological disorders, since they also affect the causes of pain - the inflammatory process.

Therapeutic blockades provide a low risk of developing undesirable effects from the administered drugs, since their active substances immediately penetrate the lesion and only then are absorbed in small doses into the general bloodstream.

Novocaine and lidocaine blockades involve injecting an anesthetic into the area of ​​maximum pain, the so-called trigger points. They are effective for pain that occurs when the tone of the back muscles increases, joint congestion, and radicular syndrome. At the same time, lidocaine blockades can only be used to relieve pain, while novocaine blockades are also prescribed for diagnostic purposes.

There are also different methods of administering drugs. There are epidural, intercostal and paravertebral blockades.

Lumbar epidural block

For lower back pain and the need for surgical intervention on the lower part of the body, the most effective is the introduction of anesthetics into the epidural space of the lumbar spine at the border with the sacrum. It is in this area that pain is usually localized when the nerve roots of the lumbar region are affected.

The essence of the procedure is as follows:

• the patient lies on his stomach or side;
• the skin is treated with an antiseptic solution;
• local anesthesia is performed in the area of ​​the L1–L5 vertebrae;
• anatomical landmarks are determined and the needle is accurately inserted between the L3–L4 or L4–L5 vertebrae (in this case, it passes through the skin, subcutaneous fat, supraspinous, interspinous and yellow ligament);
• the resistance of the epidural space boundary is carefully overcome;
• the solution is introduced slowly;
• the needle is removed and a sterile dressing is applied.

To prevent a jump in blood pressure, caffeine may be administered to the patient before the blockade, and ephedrine may be administered to people suffering from hypotension. The therapeutic effect develops immediately after injection and lasts for a long time. But this is often completely sufficient to break the chain of pain impulses, prevent the formation of a focus of excitation in the cerebral cortex and normalize the patient’s condition.

Paravertebral

Recently, paravertebral blockade of the lumbosacral region is most often performed to eliminate pain. With it, the drug solution is administered into a separate branch of the nerve in the region of the paravertebral line, passing at the level of the transverse vertebral processes without affecting the spinal cord. This results in anesthesia of a specific part of the body or internal organ, which is usually enough to eliminate narrowly localized pain or make a diagnosis.

In turn, paravertebral blockades are divided into 4 types based on the depth of impact:

• tissue - the drug is injected into the soft tissue near the affected segment of the spine;
• receptor - the anesthetic is injected into the locations of receptors responsible for pain impulses;
• conductive – the injection is carried out near the nerve root responsible for conducting pain impulses;
• ganglion - the target of the blockade is the nerve nodes.

Paravertebral blockade is performed with the patient lying on his stomach. By palpation, the doctor determines the location of the most severe pain, which is often located in the projection of the affected nerve. The skin is wiped with an antiseptic solution and novocaine is injected intradermally using a thin needle until a “lemon peel” effect is formed.

Another needle is inserted at a distance of 3–4 cm from the line of the spinous processes at the level of the desired intervertebral space. As it moves deeper, a solution of novocaine is injected in small portions until it hits the transverse process. After this, the direction of movement of the needle is changed to go around the vertebra up or down. So they immerse it another 2 cm and inject the planned amount of solution. Thus, the total depth of needle insertion is about 5–6 cm.

If there is acute pain in the lumbosacral region without clear localization, they resort to unilateral or bilateral blockades using a mixture of novocaine and corticosteroid (usually hydrocortisone) in the area of ​​the spinal cords through 3 or 6 paravertebral points. The dose of hydrocortisone is calculated individually, based on the patient’s condition, severity and location of pain.

After the blockade, the patient is recommended to remain in a supine position and preferably not move actively for at least 2 hours. You should lie on your healthy side. It is allowed to use gadgets or other entertainment means during this time.

Blockade for intercostal neuralgia

The purpose of the procedure is to deliver drugs into the intercostal space in the area where the affected nerve passes. There are:

• parasternal;
• front;
• rear;
• lateral.

The level of drug administration is determined based on the location of the injury or source of disease.

When performing the procedure, the patient should lie on his healthy side. After antiseptic treatment of the skin, intradermal infiltration is performed with a thin needle. A thicker needle is inserted into the same place strictly perpendicular to the lower edge of the rib, and then at an angle, plunging into the soft tissue underneath. When performing manipulations on the posterior parts of the ribs, the integrity of the vessels is regularly monitored by performing control aspiration.

Types of blockades

Blockades of intervertebral hernia vary depending on the location of the disease and the types of drugs administered. To choose the correct dosage of drugs, you need to pay attention to the degree of pain intensity and the disease itself:

• 1st degree: pain can only occur when changing body position or sudden movement. In other cases, pain is not observed;
• 2nd degree: mild pain is present almost constantly and is not felt only when standing still;
• 3rd degree: the pain does not stop, does not subside even with a fixed, motionless posture.

The specialist must determine the degree of pain and prescribe medication for the blockade

Blockades are used only for the second and third degrees of pain, since for the first, simpler methods can be used, for example, painkillers.

Prices for painkillers for back pain

Types of blockades: where is the medicine administered?

Blockades are classified according to several criteria, and one of them is based on the injection site. The following types are classified as epidural blocks:

• Transforaminal injection . With this method, the medicine is injected into the point where the nerve endings leave the spine. Thanks to this method, their work is blocked, and the pain recedes.

Transforaminal injection

• Intralaminar injection . In this case, the drug is administered between the vertebral processes, exactly along the midline. Doctors choose this method most often because it is less painful and dangerous - working with nerve tissue is more painstaking.

Intralaminar injection

Types of blockades: what medicine is needed?

Blockades are also classified according to the drugs administered, since analgesics differ in both drug concentration and strength of effect.

Depending on the composition, the following drugs are distinguished:

• Single-component (when only one medicine is needed).
• Two-component (requires the introduction of two drugs).
• Multicomponent (injection contains three or more different drugs).

Specific formulations are prescribed by the doctor depending on the stage of the disease, the degree of pain and which drugs are suitable for the patient’s body. For example, the following can be used:

Other drugs are also used as additional means. They themselves do not directly affect the pain relief of the hernia, however, in combination with the medications described above, they create an additional improving effect, for example, accelerating action, strengthening tissue, and normalizing blood circulation. These include:

Preparations for performing spinal blockade

Multicomponent formulations are often used, the basis of which is still known anesthetics - lidocaine and novocaine. They block the transmission of nerve impulses by inhibiting sodium channels.

Also, solutions for blockade injections may include:

• corticosteroids are powerful anti-inflammatory drugs, the delivery of which directly to the site of inflammation helps to quickly eliminate swelling and severe inflammation;
• B vitamins – help normalize the transmission of nerve impulses;
• chondroprotectors – necessary for the active saturation of cartilage tissue, restoring its elasticity and strength.

When is it time to see a doctor?

Having figured out what an epidural block is, ordinary people begin to look for alarming signs that indicate the need for it. But ordinary pain in the back is not the only signal that indicates the need to take this approach.

Between the vertebral bodies there are discs that increase the stability of the spine to vertical loads and absorb mutual displacement of the vertebrae. Many factors play a role in the occurrence of a hernia. Most often, people who engage in physical labor or office workers face this problem.

In the first case, these are heaviness that can lead to a crack in the intervertebral discs, and in the second, a prolonged position in one position, which leads to “starvation” of the discs. Discs weakened by a herniation poorly fix the vertebrae along the physiological axis of the body, increasing the load on the muscles in this place. The muscles quickly become overloaded and pain appears. Due to overload, many muscle cells die, which further weakens the muscle corset. Swelling develops in the affected area and this disrupts blood supply, which means that the cartilage does not receive sufficient nutrition, shrinks and dries out. Degenerative-dystrophic processes begin to develop, primarily affecting the fibrous ring. It quickly loses its ability to hold the intervertebral disc in its correct (anatomical) place, and it becomes more mobile. Modified discs stop functioning normally, depreciation is lost, they begin to wear out, and in some cases crack. In the future, this leads to rupture of the fibrous ring and the release of part of the nucleus pulposus beyond its anatomically normal location - the formation of an intervertebral hernia occurs.

Patients who suffer from osteochondrosis may also need a blockade. Such people are at increased risk, because this disease is the basis for the occurrence of a hernia. The disease promotes destructive changes in the cartilage tissue of the intervertebral discs.

Technology of cervical spine blockade

If it is necessary to eliminate pain in the cervical spine, the patient is seated and asked to tilt his head forward. The medical worker disinfects the skin, and the doctor performing the procedure finds the inflamed vertebra and inserts a needle two centimeters from it 3–3.5 cm deep on one side or the other of the spine.

Epidural administration of glucocorticoids in the treatment of vertebral hernias

Degenerative-dystrophic disorders and herniated intervertebral discs are the most common causes of pain in the lower back (lumbodynia) and pain radiating to the lower extremities (lumbar ischialgia).

At the same time, in approximately half of patients suffering from chronic pain syndromes, the presence of vertebral protrusion or hernia is not always diagnosed. Unpleasant sensations can be caused by disorders of the musculoskeletal system, myofascial or spondyloarthropathic (facet) syndromes, spinal stenosis or vertebral displacement.

Today there is no single and universal method of conservative treatment or surgical intervention that provides a lasting therapeutic effect and leveling of disturbing symptoms. Thus, chronic pain in the lower back and back is a pressing medical problem, especially when it affects young, able-bodied people.

According to statistics, approximately 90% of patients recover almost completely after the first acute attack of the disease thanks to classical therapy. Repeated exacerbations regress more slowly and require special treatment, and only 10-15% of patients require surgery. In this regard, an individual approach in each specific case and a thorough study of the pathophysiological mechanisms of the development of pathology are very important.

The introduction of epidural blocks for chronic pain syndrome made it possible to explore a new direction in the treatment of vertebral hernias. The effectiveness of glucocorticoid injections is assessed ambiguously, since it correlates depending on the duration of the disease, the anatomical features of the body and the pathological factors (genetic, social, professional, psychological, etc.) that provoked it.

For example, epidural administration of glucocorticoids to patients with a disease duration of 3-6 months shows a positive result in more than 90% of cases. If the disease lasts for more than 6 months, the result drops to 70%, and for more than 12 months, the effectiveness of blockades drops to 10-15%.

The occurrence of pain

Osteochondrosis is a disorder of metabolic processes in the body, causing degeneration of the cartilage of the intervertebral discs (primary disease). Over time, it enters the secondary phase - the development of reactive and compensatory pathologies in the osteo-ligamentous apparatus of the skeleton. Then there is protrusion, herniation of intervertebral discs, proliferation of osteophytes, displacement of the vertebrae, compression of the spinal nerve roots and blood vessels.

In most cases, the occurrence of back pain is the result of the combined effects of mechanical stress and damage to the spinal column, as well as the result of the action of chemical mediators. Another confirmation of the presence of a chemical component in the formation of a hernia is the identification of inflammatory mediators in the cartilage tissue of the disc, their immunogenicity and the possibility of unexpected resorption (resorption) of the protrusion.

In addition, a number of studies show that chemical mediators from the nucleus pulposus can penetrate into the epidural space through cracks in the annulus fibrosus of the intervertebral disc. This leads to inflammation of nearby spinal nerve roots, causing localized or referred pain. Thus, pathophysiological mechanisms provoke acute pain in patients in whom a protrusion or hernia has not yet formed.

Pain syndrome, depending on the sources of discomfort, can be divided into:

• Vertebrogenic, associated with degenerative-dystrophic changes in the spine and paravertebral soft tissues. Pain can come from joints, ligaments, muscle fibers, pinched nerve roots, compressed spinal cord, etc.
• Nonvertebrogenic is caused by pathological processes: stress, depression, myofascial pain, diseases of internal organs, infectious lesions, metabolic abnormalities, systemic diseases, osteopenia, tumors, etc.

Referred pain is caused by pain impulses transmitted from the affected internal organs to the corresponding areas of the spinal column. The peculiarity of these pains is the lack of connection between the occurrence of unpleasant sensations and the patient’s motor activity.

Damage and asymmetry of muscle development are observed in more than 85% of patients with protrusions and herniations of intervertebral discs. Musculoskeletal pain is usually characterized by the presence of trigger points - small pockets of local pain located in areas of muscle spasm or tension bundles. On palpation, they can be felt in the form of small balls under the skin; most often they are found in the muscles of the neck, trapezius bundles, under the shoulder blades, quadratus lumbar muscles, and pelvic girdle.

Diagnosis of muscle pain begins with identifying the affected muscle, painful lumps, active trigger points and the area of ​​pain irradiation. For treatment, massages, physiotherapy, exercise therapy, and drug therapy (analgesics, non-steroidal anti-inflammatory drugs, glucocorticoids, muscle relaxants) are initially used. Musculoskeletal pain is associated with physical overload or lack of physical activity, muscle hypothermia or infectious diseases.

Methods of administering glucocorticoids

Glucocorticoids (glucocorticosteroids) are a subclass of corticoid steroid hormones that are produced by the adrenal cortex. They have pronounced anti-inflammatory, metabolic, immunoregulatory, anti-stress, anti-allergic and other properties.

The mechanism of action of steroids during epidural blockades is based on changes in nociceptive signals, reflex impulses in centripetal fibers and the functional state of neurons. They also neutralize the release of phospholipase (an inflammatory mediator) and the synthesis of anti-inflammatory cytokines, providing a secondary analgesic effect.

For myofascial pain syndrome, local injection of a cocktail of steroids (for example, hydrocortisone) and anesthetic (novocaine, lidocaine) into trigger points of the affected muscle fibers is practiced. The course of treatment consists of 3-5 injections with an interval of 2-3 days. After 6-12 months, you can take a second course of therapy. The effectiveness of local muscle blockades is much higher when used in combination with other types of conservative treatment.

Epidural blocks are most often performed in the lumbar spine. They also use a mixture of anesthetics and glucocorticoids (betamethasone, diprospan, prednisolone, etc.). As a rule, they are used to quickly and effectively relieve pain.

Despite the fact that there are numerous groups of patients who respond positively to this type of therapy, many experts cannot recommend epidural administration of glucocorticoids for widespread use. This is associated with a high risk of complications after intervention in the membranes of the spinal cord.

Intra-articular and intraosseous injections, blockades of the median branches of nerve trunks in the treatment of vertebral hernias are used much less frequently. They significantly reduce the intensity of pain and compensate for the functional deficiency of the affected segment, but are more suitable for the treatment of various types of arthrosis, arthritis, osteoporosis, spondylitis and other diseases of the spine.

Epidural blocks

The introduction of fluoroscopes into the practice of minimally invasive surgery has significantly reduced the risks and morbidity of epidural administration of glucocorticoids. In this case, the median intralaminar method of access to the affected spinal motion segment is considered more preferable than the transforaminal one.

Routes of epidural drug administration:

• Caudal (inferior, below the pathological site) access is technically easy to perform, quite safe (the risk of deformation, damage or puncture of the dura mater of the spinal cord is practically absent), but requires the administration of a fairly large volume of drugs (from 10 to 20 ml).
• Intralaminar access (between the vertebral arches) allows you to more accurately reach the pathological area and requires a much smaller dose of the administered drug.
• Transforaminal (through the vertebral foramen) approach is considered the most optimal when accessing a compressed nerve root and requires a small volume of cocktail.

The choice of route of drug administration depends on the individual characteristics of the patient’s spinal structure, the location of the hernia, as well as the experience and preference of the neurosurgeon who performs the intervention.

The disadvantage of treatment with epidural glucocorticosteroid blockades is:

• lack of certain standards and regimens for the use of various drugs and their doses;
• the need to comply with strict patient selection criteria (many patients are contraindicated for this type of intervention);
• lack of appropriate monitoring of the patient's condition, especially if blockades are used in combination with other types of treatment;
• Long-term use of glucocorticoids causes a number of side effects (diabetes mellitus, endocrine system disruptions, persistent increase in blood pressure, osteoporosis, etc.).

Thus, epidural administration of glucocorticoids is a reasonable alternative to other types of treatment (surgery or other minimally invasive interventions), especially in patients in whom the chemical components of hernia formation dominate over the mechanical ones.
Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Technology for blocking the lumbar and lumbosacral spine

The patient lies on his stomach. The skin is treated with an antiseptic solution. The doctor finds the vertebral process in the area where pain is localized and inserts a needle 2-3 cm from the center line of the spine, always at a right angle. The drug is administered after the needle is immersed 3–4 cm. Typically, injections are made on both sides of the spine.

If it is necessary to numb the sacral region, the patient should lie on his side and pull his knees to his chest. This ensures an increase in the spaces between the processes of the vertebrae and increases the convenience of manipulation.

Types of blockades

For intervertebral hernias, two types of blockades are used:

• epidural intralaminar administration: the drug reaches the midline between the vertebral processes;
• transforaminal anesthesia: the drug is injected into the area where the spinal nerve exits the intervertebral foramen.

The first option of the procedure is considered more effective. Among the effects are a decrease in inflammation, relief of swelling, and relief of pain.

There are different types of blockades, the choice of technique is determined by the doctor

Contraindications to the procedure

A back block, even with severe pain, cannot be done if:

• bleeding disorders, in particular with hemophilia or the patient taking anticoagulants;
• infectious disease;
• myasthenia gravis;
• sick sinus angle syndrome;
• severe cardiovascular diseases;
• severe bradycardia, arterial hypotension;
• disruption of hematopoietic processes;
• allergies to novocaine or lidocaine;
• epilepsy;
• increased vascular tone;
• pregnancy and lactation;
• serious kidney disease;
• liver failure;
• mental disorders.

Also, the procedure is not performed on patients who are unconscious. Even if the patient has not previously experienced an allergic reaction to the drugs used, allergy tests are performed immediately before the blockade to determine sensitivity to them. For this purpose, the skin is lightly scratched with a scarifier and a drop of the drug is applied to this area. In the absence of redness, swelling and other signs of allergy, blockade injections using it are allowed.

Execution technique

The patient lies on the couch; the position taken should not cause pain. The anesthesiologist determines the injection site. In general, several injections are given in different places. The effect of anesthetic on the affected area helps eliminate spasm and pain. The injection lasts for about a month. In some patients, the pain does not go away completely, but only subsides. In such cases, a course of treatment is required.

Immediately before the invasion, the injection site is treated with an antiseptic solution, the manipulation is carried out using a thin, long sterile needle. Anesthesia is given on both sides of the vertebra. Usually, lidocaine, novocaine, or a combination of the latter with hydrocortisone is taken for the blockade. The doctor’s task is to administer injections in increments of 1.5 cm along the spinal column. The depth of needle insertion is 2–3 centimeters.

The procedure is not the most pleasant, but the patient should try not to move. To reduce discomfort, the injection site is pre-treated with an anesthetic. The needle is first inserted all the way, then partially removed and directed towards the process by about 2 cm. The optimal number of invasions is six points on each side of the spine. The manipulation is carried out under the control of equipment, using x-ray data.

When performed correctly, the positive effect occurs very quickly: muscle spasm is eliminated, signs of inflammation disappear, and mobility improves.

The procedure is carried out using a special long needle.

Possible complications

The vast majority of complications of a back block are caused by a violation of its technique. Therefore, they can be easily avoided by turning to highly qualified specialists who thoroughly understand the methodology of the procedure. Block injection carries the following risks:

• puncture of the dura mater of the spinal cord, which is fraught with penetration of the drug solution into the arachnoid mesh, a decrease in intracranial pressure and the appearance of severe headaches;
• injury to a blood vessel and the introduction of an anesthetic into it, which can lead to numbness of a part of the body and the formation of a hematoma;
• infection is possible if sterility is not observed during the procedure, which is accompanied by redness, soreness of the affected area of ​​soft tissue, and sometimes suppuration;
• temporary neurological disorders are observed when the nerve fiber is damaged, the risk is 0.1%.

Can complications arise?

As a rule, complications do not occur when introducing a blockade of an intervertebral hernia if everything is done correctly. But if the procedure is not performed carefully, there is a possibility of damage to the soft tissues of the back, which can cause bleeding, infection, or disruption of the spinal cord. In this case, urgent medical intervention is necessary to avoid irreversible consequences. Therefore, the procedure should be carried out strictly in medical institutions and exclusively by an experienced specialist.

Before carrying out the blockade, the doctor examines the body's reaction to the administered substance with a test injection of a weak concentration. This helps determine whether a particular drug is appropriate for this patient.

The use of a blockade is not at all dangerous if it is carried out by a qualified doctor in suitable conditions. There is no need to be afraid of this. If you have no contraindications and need such a procedure, then contact a medical facility.

Don't be lazy to see a doctor if something bothers you

Remember - with the primary symptoms of a spinal hernia, it is better to immediately consult a doctor, so that later you do not have to treat the disease in an advanced stage. Don’t be too lazy to find time to undergo diagnostics – you should treat your health with care. Thanks to the capabilities of modern medicine, specialists can easily determine the stage of the disease and help cope with it.

Spinal block at SL Clinic

At SL Clinic, blockades are performed by fully trained medical professionals, which guarantees absolutely precise adherence to the manipulation technique and the absence of complications. With us you can make any type of blockade. The doctor will individually select the most effective method of eliminating pain. Each procedure is indicated in the price list.

Prices

The cost of the blockade is from 1000 to 5000 rubles and depends on: - The cost of the drugs that we administer; — Clinics where the blockade will be carried out. - Number of blockades. — Type of blockade (paravertebral, epidural, etc.) The price includes: — Medicine; - Syringes with a needle. — The clinic where the blockade will be carried out; — Type of blockade administration (paravertebral, epidural, etc.) — Number of blockade sessions; — Observation and consultation during the rehabilitation period.

We also suggest that you not only fight the manifestations of the existing disease, but also the disease itself. Qualified vertebrologist-surgeons and doctors of other specialties will be able to thoroughly understand the causes of pain and select the optimal treatment tactics.

Diagnostics at the SL Clinic are carried out using modern equipment of the latest generations, which makes it possible to detect the slightest deviations from the norm and effectively treat them with conservative therapy. If it is ineffective or in advanced cases, we can offer you rapid surgical treatment of existing diseases using the latest methods, characterized by low invasiveness and a high level of safety. With us you will not find queues, careless and inattentive attitude towards patients. We sincerely care about your health and are ready to go with you on the long path to spinal health. Make an appointment with the right specialist now by calling.

What complications can there be?

Complications can arise if the procedure is performed ineptly, or if the doctor is insufficiently qualified or lacks experience. The best thing that can happen in such cases is that the blockade has no effect. More serious consequences include the presence of immediate allergic reactions, the development of minor bleeding, and the formation of hematomas. Before the injection, the doctor must collect an allergy history from the patient.

An extremely dangerous complication that can occur with any invasive intervention is infection. This rarely happens now, since all health care facilities and health workers are subject to very strict requirements for compliance with the rules of asepsis and antisepsis. To carry out blockades, disposable sterile instruments, sterile medicinal solutions and additional materials are used.

Blockade in the spine: consequences and their prevention

Complications occur only in 0.5% of cases. These may include unexpected reactions to medications such as dizziness, vomiting, or increased heart rate. Damage to blood vessels at the injection point with the formation of a hematoma, infection and bleeding is also possible. Allergic reactions are possible. For preventive purposes, additional injections are given, and a test test is performed to prevent allergies. Our center has all the conditions for safely performing therapeutic blockades that will relieve you of debilitating pain for a long time. You don't have to worry about possible consequences or poor quality pain relief.

We employ high-level specialists with extensive experience, making patients feel comfortable and confident. If necessary, you will be prescribed one or more intra-articular injection procedures and a drug will be selected based on the indications.

Classification of epidural block

The price of a pain relief technique directly depends on what type it belongs to. According to their purpose, blockades are divided into diagnostic, prognostic and therapeutic. This route of administration is used for local anesthetics, as well as nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids.

To choose in favor of a certain category, a specialist must first study the victim’s complaints, his medical history, and test results. But, regardless of the decision made, the composition must be administered in such a way as to have the maximum effect on the lesion. The blockade will not cure the original source of the problem, but it will significantly improve the patient’s quality of life during the period of rehabilitation therapy.

The drugs used are divided into two groups: basic (basic) and additional. Due to the rapid onset of analgesic action, local anesthetics have found greatest use as a base agent for all types of blockades (diagnostic, prognostic and therapeutic). Unfortunately, their duration of action is several tens of minutes. In addition, they do not have anti-inflammatory and anti-edematous activity, so they use a second group of additional drugs that have these properties. These include hormonal agents (glucocorticoids).

Separately, the second group of pharmacological agents is administered very rarely, since it does not have a direct analgesic effect. Together with an anesthetic it is possible to achieve the ideal combination.

But trying to independently select a set of medications for yourself at home without prior consultation is a dangerous undertaking. With such amateur activities, the percentage probability of allergies increases significantly. Also, attempts to make you feel better without medical advice greatly blur the clinical picture, or even cause additional trauma to the nerve endings.

Technique

The mechanism of this manipulation is based on the rapid penetration of medicinal substances into the subarachnoid space through the dural couplings, which contributes to the formation of a blockade and obstruction of impulses into the spinal cord along the radicular nerves. The drugs are administered into the epidural zone using a catheter.

No special preparation is required before performing an epidural block. It can be applied to all parts of the spine: cervical, thoracic, lumbar, sacral.

The procedure itself is carried out in one of the following ways:

1. Intralaminar - when, when administering the drug, the syringe needle is directed along the midline between the processes of the spine;
2. Transforaminal - when the injected drugs come from the intervertebral foramen to the exit of the spinal nerve.

Before the procedure, the doctor will tell you briefly about how the pain relief will go and warn you about the need to report your current state of health during the administration of medications.

The blockade is carried out for quite a long time, so for at least two more hours after its completion, the patient should be under the supervision of medical personnel.

Usually, the intervention is not accompanied by significant discomfort, but sometimes you have to put up with manifestations of weakness and temporary numbness of the upper and lower extremities. This is a very typical reaction of the body to anesthetics.

Schematically, the procedure looks like this:

• the person is laid on his side with his legs bent;
• knees are brought to the stomach;
• disinfect the skin;
• palpate the area where the hernia is likely to be located;
• provide pain relief;
• make a puncture.

For injection, a needle with a diameter of 60 mm is used.

Next, the doctor changes the stroke of the needle to reach the horizontal level, inserting to a depth of approximately 50 mm. To make sure that the site is chosen correctly, the doctor first draws fluid from the area where the needle was inserted. If the fluid contains blood, then the needle is moved to move outside the blood vessel.

When cerebrospinal fluid appears in the syringe, the movement is stopped.

The blockade itself is often accompanied by noticeable discomfort, so the doctor will try to administer the drug as slowly as possible. In one go, it is allowed to administer from 30 to 60 ml of the drug.

To increase productivity, patients will have to remain in a supine position on the painful side for about forty minutes upon completion of the manipulation. During this time, the victim may experience slight bleeding at the puncture site, but this is completely normal.

Drugs

Anesthetics

Injections with Novocaine are given into nerves and soft tissues. After administration, nerve innervation is blocked, nutrition and cell resistance to allergens are improved. Novocaine has a bacteriostatic effect and has a high safety profile, rarely causing adverse reactions. Lidocaine provides a longer and more pronounced effect compared to Novocaine. It is based on the inhibition of voltage-gated sodium channels, due to which nerve signals cease to be generated and their transmission to the brain stops. Lidocaine dilates blood vessels and relaxes muscles. The pain disappears a few minutes after it enters the tissue.

Important! Lidocaine is less toxic than Novocaine.

Hormones

Dexamethasone is a fast-acting anti-inflammatory drug with prolonged action. It suppresses the activity of the immune system and has an antihistamine effect. Dexamethasone is one of the drugs of choice for diseases of the musculoskeletal system. Eliminates unwanted reactions to local anesthetics and is ten times more effective than hydrocortisone. Diprospan is used for joint diseases and heel spurs. Quickly relieves pain and discomfort, relieves allergic manifestations. Bone growths on the heel disappear after 1-2 procedures. The product can be used for epidural and perineural blockades. The only drawback is the possible side effects common to all corticosteroids. However, compared to analogues, the risk is lower.

Vitamin B12

The use of cyanocobalamin is justified by its ability to have a ganglion-blocking effect, that is, to inhibit nerve conduction. Vitamin B12 is usually administered in combination with B1 and Novocaine. The main indications are neuritis and polyneuropathy.

Contraindications for

The effectiveness of the technique has been proven in practice many times. But it is not ideal for all patients. To eliminate the risks of worsening the condition, the doctor must take into account the patient’s characteristic contraindications. These include:

• destabilization of the cardiovascular system;
• severe liver or kidney diseases;
• disturbances in the functioning of the central nervous system;
• fever of unknown etiology;
• pregnancy.

Also, such manipulation will have to be postponed if a person has an infectious lesion of the skin in the area of ​​the intervention. We are talking about pustular formations, infected open wound surfaces, and burns. The likelihood of complications of certain chronic diseases is taken into account.