Paravertebral blockade: technique and indications

What is a spinal block?

A hernia is accompanied by pain, which intensifies as the intervertebral discs change. The more advanced the pathological process, the more pronounced the pain syndrome becomes, and stiffness in movements appears.

Kazieva Aminat Ziyavovna

Neurologist

Rostov State Medical University

Experience since 2012

A blockade for a spinal hernia relieves pain, including acute, burning pain. The procedure involves the injection of anesthetic solutions directly next to the spinal column, at the site of compression of the nerve roots. The analgesic effect occurs within 3-5 minutes and lasts from 30 minutes. up to several hours. Soreness may return after this time, but it becomes less pronounced. If necessary, a course consisting of 5-7 procedures is carried out.

Photo. A persistent analgesic effect ensures a full course of therapeutic blockades

When blocking nerve roots, the drug acts directly on the nerves. After the anesthetic is administered, it envelops the nerve sheaths and blocks the transmission of pain impulses. As a result, the innervation of the affected area is switched off.

When the spine is blocked for osteochondrosis, spondylosis, protrusion or herniated intervertebral discs, in addition to pain, the patient gets relief from numbness, tingling, burning, sensory disturbances and other neurological symptoms associated with pinched and irritated nerves. Benefits of the procedure:

• immediate analgesic effect;
• effectiveness in severe pain when neither tablets nor intramuscular injections help;
• a small number of side effects due to local action;
• safety of the procedure (if the blockade of pain (trigger) points is performed by a qualified specialist);
• wide range of applications - osteochondrosis, spondyloarthrosis, intervertebral hernia, neuralgia, myofascial syndrome, radiculitis and others;
• the possibility of repeated testing during exacerbation of pathologies of the musculoskeletal system;
• injection of anesthetic is not painful.

A spinal block is the most effective procedure for treating acute back pain. But it is not a complete therapeutic method for diseases of the spinal column. Most effective against radicular or reflex pain syndrome.

There are therapeutic spinal blockades that specifically target the cause of pain. We are talking about injections of hydrocortisone and other glucocorticoid hormones. They have not only analgesic, but also anti-inflammatory and anti-edematous effects.

The doctor decides which drugs to use for spinal blockade, depending on the indications and severity of the patient’s condition. The procedure is carried out in a treatment room under absolutely sterile conditions in compliance with aseptic rules.

Spinal block is exclusively a medical procedure

A spinal block is available at a medical clinic that specializes in the treatment of neurological diseases:

• osteochondrosis of the cervical, thoracic, sacrolumbar region;
• intervertebral hernia;
• spondyloarthrosis (arthrosis of the intervertebral joints);
• intercostal neuralgia;
• sciatica (compression and irritation of the sciatic nerve);
• radiculitis, radiculopathy (radicular syndrome, in which compression of the spinal nerve roots occurs);
• myofascial syndrome (formation of trigger points in muscles);
• traumatic damage to the vertebrae, soft tissues and nerves surrounding the spine, which is accompanied by pain.

Patients of the SmartMed clinic have access to a full range of services: from consultation with a neurologist and diagnostics to treatment. The medical center has a treatment room where lumbar and other back pain is blocked.

Possible side effects

Side effects occur in rare cases if the doctor made a mistake, the patient had an incompatibility with the drug being used, the dosage of the drug was incorrectly calculated, or two inappropriate drugs were mixed. As a result of this, the following problems may occur:

• infection due to a non-sterile medical device;
• increased pain;
• skin pigmentation;
• bleeding in cases where the patient has poor blood clotting;
• excess calcium in joints or muscles;
• violation of the integrity of the joint or cartilage;
• avascular necrosis.

Side effects do not necessarily occur. According to medical statistics, the chance of such an outcome is 3-5%.

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.

Provoking reasons

The nature of shoulder pain is difficult to determine, since it is provoked by various pathological abnormalities. In addition, the symptom is divided into two types: internal and external.

Pain inside shoulder

Pain inside the shoulder can be caused by:

• degeneration or tear of the rotator cuff;
• unstable condition of the head of the humerus;
• excess calcium in the tendons of the shoulder;
• glenohumeral pathology;
• acromioclavicular disorder;
• excess calcium in the muscle structure, biceps;
• various types of infections (HIV, AIDS, etc.);
• fragmentation of the cartilaginous bag.

These reasons most often provoke pain inside the shoulder.

Pain on the outside of the shoulder

There are only a few reasons that can provoke pain on the outside of the shoulder:

• Referred pain. It is a “reflection” of pain in other parts of the body. The symptom may be caused by discomfort in the diaphragm, cervical spine or liver.
• Oncological lesion.

According to medical statistics, patients often seek help with referred pain, much less often with cancer.

Preparations for performing spinal blockade for hernia

A spinal block is prescribed by a neurologist or vertebrologist, who also determines the dose and type of drug. For hernia, both mono- and multi-component compositions are used.

All drugs that are used for blockade can be divided into 2 groups:

• Anti-inflammatory. These include hormonal medications that reduce inflammation and swelling and have a therapeutic effect.
• Painkillers. The main purpose of drugs in this group is to block the transmission of pain impulses. To eliminate pain when a nerve is pinched, injections of Lidocaine or Novocaine are given.

Mixed formulations are often used - a mixture of anti-inflammatory and painkillers. Injections with hormonal drugs alone are less effective, and they are also painful.

Note! Therapeutic blockades for radiculitis, hernia, osteochondrosis are safe in medicine, practically not accompanied by side effects, since the active substance is administered locally, to the lesion. It enters the general bloodstream only in small doses.

Novocaine

It is a local anesthetic, relieves muscle spasms, and has a pronounced analgesic effect. The blockade effect occurs within 10-15 minutes.

Although spinal blockade with novocaine is considered one of the safest in medicine, patients often experience allergic reactions, so other anesthetics are used.

Lidocaine

Lidocaine blockades are performed at the SmartMed clinic. Lidocaine is less toxic and provides a faster and longer lasting analgesic effect than Novocaine. In addition, lidocaine solutions have a vasodilating effect and do not cause an increase in blood pressure.

Diprospan

This is a hormonal drug based on betamethasone. It not only relieves inflammation, but also relieves pain, does not cause allergic reactions, and provides a long-lasting effect.

Diprospan can treat any destructive-degenerative diseases of the spine, spasm of the gluteal muscle. It is suitable for vertebral and epidural administration.

Hydrocortisone

Less effective than Diprospan. Hydrocortisone blockades are indicated for patients with mild pain syndrome, since its analgesic effect is short-lived.

Hydrocortisone is most often used in multicomponent formulations because it prolongs the action of anesthetics

The main advantage of the drug is its low cost.

Depo-Medrol

Refers to hormonal drugs. The medicine is used to block soft tissues and joints, including not only facet joints, but also knee joints. It is not suitable for vertebral or epidural manipulations, but is ideal for periarticular blocks.

Note! To restore bones and cartilage tissue of the knee, hormonal drugs can be combined with chondroprotectors. mineral complexes.

Dexamethasone

Has a prolonged anti-inflammatory effect. It is 25-30 times more active than Hydrocortisone, so in severe cases it is preferred and combined with lidocaine solutions.

Contraindications

Diprospan injections, the instructions for use warn about this, have an absolute contraindication - hypersensitivity to betamethasone or any of the auxiliary components. There are many other contraindications for the use of the drug, so you need to know why diprospan is dangerous.

The drug is not prescribed for the treatment of diseases of the skeletal system in the presence of septic and infectious lesions of the joint, as well as in the presence of periarticular osteoporosis or intra-articular bone fracture. The drug cannot be used in the post-vaccination period. It is unacceptable to treat diabetes mellitus, hypothyroidism and hypertension. Before using the product, the doctor must exclude other possible risks that are associated with contraindications.

The drug can be prescribed for the treatment of severe infectious diseases only in combination with other targeted drugs in specific therapy regimens. You should stop using the medicine if you have pathologies of the digestive system, such as peptic ulcers, diverticulitis, gastritis, etc. Treatment of children with the drug is possible only after 3 years. Pregnancy and lactation are conditional contraindications, since studies of the effect of the drug on the woman’s body in such conditions have not been conducted.

How to do a spinal block:

Depending on the technique used, spinal blockade is done in 3 ways:

• paravertebral;
• epidural;
• articularly.

The doctor selects the injection site taking into account the location of the pathology.

Paravertebral

The solution is injected into the area closest to the damaged vertebra, in the area where the nerve passes at the level of the transverse vertebral processes. There is no interference with the spinal membranes.

For paravertebral blockade, the needle is inserted to a depth of 5-6 cm

Epidural

It is used for lumbar hernia and blocks the roots of the spinal nerves. It involves the introduction of a medicinal solution into the epidural space - the area between the periosteum of the vertebrae and the dura mater of the spinal cord.

Kazieva Aminat Ziyavovna

Neurologist

Rostov State Medical University

Experience since 2012

The blockade is carried out in a position on the side, less often - lying on the stomach.

Articular

Involves the introduction of medication into the cavity of the facet joints. Most effective for lumbar hernia.

The SmartMed clinic uses a relatively new method of pain relief - periarticular block. The anesthetic is injected into the muscles, tendons and ligaments that surround the joint, that is, into the periarticular tissue.

Rules for the introduction of "Diprospan"

If the drug is prescribed for intramuscular administration, one to two milliliters of the drug is usually prescribed. If it must be injected into the periarticular area, in this case zero point two milliliters are injected per square centimeter of the joint surface. If the drug must be administered inside the joint itself, then the dosage is a maximum of two milliliters per injection, the drug is administered no more than once a week.

Which doctor performs the therapeutic blockade?

A blockade can only be performed by a qualified neurologist who knows its technique, indications and contraindications, possible complications, and also has perfect knowledge of anatomy and the structure of the spine.

An untrained professional can cause irreparable harm. If the blockade technique for pain in the spine due to a hernia or the rules of asepsis are not followed, the manipulation is dangerous. The following consequences are likely:

• damage to nerve endings with subsequent disruption of the innervation of certain areas of the body;
• paresis, paralysis;
• infection of the spinal cord with the development of myelitis and other infectious complications.

When contacting professionals, a spinal block is an absolutely safe procedure, an effective method of treating acute and chronic pain in neurology. Fear of pain from an injection or damage to the spinal cord is unfounded if the manipulation is performed by an experienced doctor.

Novocaine or other anesthetic blockade of the spine does not hurt. There are unpleasant sensations at the beginning of the manipulation, but they are tolerable and are caused by the needle itself. No additional anesthesia is required.

After the blockade, a three-stage pain reduction occurs

As for the risk of damage to the spinal endings, it is practically zero. The needle is not inserted into the spinal cord or spine, but into the soft tissue that is near the pinched nerve, spasmed muscle, or other source of pain. There is no need to be afraid.

Note! After a spinal block is performed, skin sensitivity may decrease at the injection site, but this is a temporary side effect. Other negative reactions are also likely: headache, dizziness, decreased blood pressure, nausea.

Kazieva Aminat Ziyavovna

Neurologist

Rostov State Medical University

Experience since 2012

Make an appointment with a neurologist at the medical office. The doctor will tell you in detail how and why the blockade is done, whether it is suitable for you, whether the procedure is painful, and what consequences may occur after it.

Types of injections

Many drugs are used for injection. The wide range is due to the large number of patients; not everyone is suitable for a certain drug (allergies or other reasons).

The most common group of drugs are steroids if there are problems with the shoulder joint. Corticosteroids help restore the integrity of the rotator cuff, and intra-articular injections reduce pain.

Most often, steroids or lidocaine are used for relief. The medicine has a short duration of action, but it relieves the uncomfortable symptom well.

Reviews

In general, reviews of Diprospan are positive. Some patients have experienced side effects, but this is more rare.

Alexey, 53 years old:

“Whatever pills I took (osteochondrosis), injections were given - and everything was useless! As soon as I injected 1 mg of Diprospan, the pain on my right leg disappeared after the second injection! The pain also disappeared on my left leg. Now I’m not just walking, but jumping with a weight of more than 100. Save-and-for!”

Elena, 35 years old:

"Perfect!! It didn’t just relieve pain, but raised mood, vitality and performance... It’s a pity that it can’t be used often.”

Ivan, 47 years old:

“Very effective and strong drug. The main thing is not to abuse it - after frequent use for many years it causes terrible side effects.”

Review of "Diprospan" for osteochondrosis

Renat, 37 years old:

“One of the best anti-inflammatory drugs of the corticosteroid group. The effect comes quickly and lasts a long time due to the presence of two components. True, it is now very difficult to find it in pharmacies. Even medical representatives of the manufacturer’s company cannot give an answer to this problem. Excessive prescription of this drug in the Russian Federation is not according to indications.”

Andrey, 62 years old:

“Personally, Diprospan helped me a lot. I worked in a mine for many years. My back hurt almost constantly. The doctor prescribed Diprospan, but warned: there are too many side effects. After the injection, the pain went away almost within a few hours. Fortunately, side effects were avoided, the main thing is not to overuse)).”

Anna, 42 years old:

“Osteochondrosis simply tormented me; I didn’t know what to do with this pain. It’s chronic and you can’t just calm it down. They prescribed Diprospan, I read the reviews - they say it’s effective. At first there was relief, and then somehow everything disappeared, again the same torment. I don’t even know whether to recommend this medicine; on the one hand, it helped, but on the other, it was short-lived. Maybe it was worth repeating the injection, but I was afraid. Better decide with your doctor"

Reception features

When treating habitual dislocation, it is not recommended to use the drug “Diprospan” as a medicine, since with this problem the medicine will not be able to give a positive effect, so its use in this situation is not advisable.

Important! During the use of glucocorticosteroids, it is necessary to carefully monitor the patient's blood sugar level.

The administration of glucocorticosteroids is contraindicated intravenously or subcutaneously. Insertion into the intervertebral space and intervertebral disc is also not recommended.

It must be remembered that glucocorticosteroids and alcohol are two substances that are incompatible with each other. That is why taking any alcoholic beverages should be stopped several days before starting a course of glucocorticosteroid therapy.

While taking the drug, you must follow certain rules

During the course of drug therapy with Diprospan, the patient must also give up low- and high-alcohol drinks of any kind. This combination of substances in the body can lead to an increase in all the side effects of the drug. When taking alcohol together with glucocorticosteroids, as well as when overdosing on the drug, the patient will experience side effects of this drug, but several times stronger than they exist with normal treatment. The main thing is that in case of an overdose of glucocorticosteroids, the symptoms cannot be relieved with an antidote, because it does not exist. In this condition, the patient is treated symptomatically. The first thing to do is to remove the excess substance from the body using detoxification therapy. It is carried out by infusing the patient with glucose solution intravenously.