Knee joint block: technique and preparations

an opportunity to install a blockade in Krasnoyarsk at the KIT clinic. Patients with injuries, neurology, inflammation of various types, and acute pain syndrome come to us for this service. Therapeutic blockades act on the source of inflammation, relieving pain and stiffness. The composition may contain anesthetics or glucocorticosteroids.

The blockade is highly effective. Why?

• A lidocaine blockade quickly numbs the entire affected area. The injection is administered directly into the conductor of the nervous system.
• They can be carried out repeatedly. The pain can be relieved by injecting directly into the source of inflammation, without affecting healthy nerves. Therefore, a diprospan blockade can be administered at each exacerbation.
• Almost complete absence of complications. The painkiller has a lesser effect on the entire body, since only a small dose enters the general bloodstream.
• Vector positive dynamics. The injection also treats inflammation, restores trophism, reduces spasms and swelling.

The appointment is conducted by traumatologists

Denis Ivanovich Burmakin - Deputy Director for Medical Affairs, orthopedic traumatologist. Extensive experience in emergency traumatology, pediatric orthopedics, and rehabilitation after injuries.

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Bryukhanov Anatoly Valentinovich - microsurgeon.

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Bryukhanov Vladimir Innokentievich - traumatologist-orthopedist, highest qualification category, Honored Doctor of the Russian Federation, work experience of more than 35 years.

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Zotov Vyacheslav Viktorovich - orthopedic traumatologist.

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Pospelov Yuri Vladimirovich - orthopedic traumatologist.

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Klimov Vladimir Aleksandrovich - orthopedic traumatologist. Operating traumatologist-orthopedist.

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Dmitry Anatolyevich Shcherbovich - orthopedic traumatologist, chiropractor, physiotherapist, first medical category, 13 years of work experience. Head of the rehabilitation department.

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How is a knee block performed?

All procedures are performed only in a medical facility by a qualified physician. The injection is administered at the doctor's discretion - in the inner part of the knee or in the outer part. It depends on the nature of the pathological process. After the procedure, you should limit physical activity and minimize joint stress for half an hour. Thanks to this technique, the quality of human life significantly improves.

The use of a therapeutic blockade is advisable in order to relieve pain and get rid of other neurological symptoms. This is an effective method that works within a short period of time. The advantage of this technique is its safety for the body and a minimum of side effects.

With the help of a therapeutic blockade, three-phase relief of pain occurs:

1. Initially, the pain worsens as the pain receptors are irritated by the needle.
2. Further, the pain syndrome is reduced to a minimum.
3. In the third phase, a therapeutic effect occurs, the unpleasant sensations completely disappear. After the effect of the drug wears off, the discomfort returns, but it is not so intense.

Doctors recommend following certain rules after such a procedure - reduce physical activity, immobilize the sore joint. In advanced situations, the patient needs to immobilize the damaged area for a while.

According to rheumatologists, orthopedists and traumatologists, this technique of directly introducing drugs into the joint cavity or periarticular tissue helps to quickly restore a person’s ability to work. It is considered the most effective, especially if you need to provide quick assistance.

The main advantages of this method include:

• the ability to perform repeated exposure to the damaged area;
• quick relief from painful sensations;
• minimal risk of developing consequences;
• direct effect on the desired area, drugs are not absorbed into the systemic bloodstream or digestive system;
• rapid pain relief;
• the ability to get rid of vascular and muscle spasms, the inflammatory process;
• The procedure can be performed multiple times for each exacerbation;
• the ability to restore trophism in tissues and get rid of swelling.

The main indications for injections are the following pathological processes:

• synovitis - accompanied by inflammation of the periarticular bursa;
• arthritis - reactive, rheumatoid, ankylosing spondylitis;
• serous arthritis - is a consequence of injury, surgery or any other type of damage to the joint;
• bursitis;
• tenosynovitis;
• periarthritis.

Drugs used to block the knee joint

In order to carry out the procedure, doctors use local anesthetics. Let's look at each medicine in more detail.

Novocaine

It is injected into nerve fibers or tissues. It has analgesic and antispasmodic effects. Severe irritation occurs at the site of the disease after administration of the drug, thus innervation in peripheral tissues is significantly reduced. Thanks to this drug, the permeability of vascular walls decreases, trophism in tissues improves, antiseptic and bacteriostatic effects are achieved, vascular tone and trophism of nerve fibers improves. This remedy is considered one of the safest. It relieves pain and does not provoke the development of negative reactions.

Lidocaine

This is a local anesthetic. After administration, a long-lasting and intense effect is ensured. After the injection, sodium channels are blocked, as a result, the generation of neural impulses stops and their conductivity decreases. The pain syndrome is eliminated, the vessels dilate without irritation. Already 5 minutes after the injection, the severity of unpleasant sensations decreases, and the muscle system relaxes.

Bupivacaine

The drug belongs to amides. It acts slowly, much longer than other drugs. At the same time, the effect of its use is longer lasting. This prolonged effect is due to a longer half-life, since the active substances are transformed and synthesized not in the blood plasma, but in hepatocytes. The first result can be felt 10-15 minutes after administration.

Hydrocortisone

This is a drug that has a long-lasting effect. It contains synthetic hormonal substances; their structure is similar to those substances produced by the adrenal glands. After administration of the drug, its active substances accumulate in the tissues, and the inflammatory process is stopped. This is an inexpensive remedy. It is usually used in parallel with lidocaine. The result is felt within 24 hours after the procedure. Negative consequences after administration include increased blood pressure. The drug is used in the treatment of neurological diseases.

Dexamethasone

This is a long-acting drug that belongs to the group of glucocorticosteroid drugs. This is a very strong medicine that has a pronounced anti-inflammatory, antihistamine, and immunosuppressive effect. Recommended for use with anesthetics. The action comes quickly.

Depo-Medrol

Has a pronounced prolonged effect. The drug is injected into the synovial cavity of the joint. The procedure should only be performed by a qualified specialist to avoid the risk of the needle getting into large vessels. If there is no effect from the injection, the procedure is not repeated.

Diprospan

The key active substance is betamethasone. After the injection, pain and inflammation are quickly relieved, and allergic reactions are eliminated. The disadvantage of the drug is its negative effect on the tissues of the adrenal glands and pituitary gland.

Instructions for use

The drug is intended for intramuscular administration. It cannot be injected into a vein or subcutaneously. In this case, the injection is carried out deep into a large muscle. It is important to prevent the drug from getting into other tissues to prevent their possible atrophy. In severe conditions that require emergency measures, 2 ml of the drug is prescribed.

To the question: how often can diprospan be injected intramuscularly, the attending physician must answer in each specific case. He will also select the necessary dosage for the treatment of a particular pathology. Diprospan injections should be used based on the information provided in the instructions for use.

Uncontrolled use of a hormonal drug can lead to an overdose, which is dangerous with various negative consequences for the body. Severe vomiting, nervous agitation, and a jump in blood pressure may occur.

Reviews when the drug is prescribed correctly are always positive. Patients focus on rapid relief and elimination of painful symptoms. The affordable price of the drug is also attractive.

Diprospan ampoules should be stored at room temperature in a dark place out of reach of children. This drug has many analogues, but only a doctor should select a replacement.

Complex treatment of joints with drugs

Treatment of joint diseases is carried out using the following drugs:

• painkillers. These medications have a pronounced analgesic effect, but the result after administration is short-lived;
• corticosteroids – Prednisolone, Kenalog, Diprospan. Medicines have a pronounced anti-inflammatory effect, but they cannot be used too often, since there is a danger of developing dystrophic-degenerative processes in the joint;
• chondroprotectors – Fermatron, Alflutop, Ostenil, in combination with hyaluronic acid, help replenish the lack of joint fluid;
• vitamin preparations – Milgamma. The medicine improves tissue nutrition and helps them recover.

Content

• Benefits of blockades
• How to do a blockade for leg pain
• Treatment of knee joint diseases with blockades

• Cost of treatment
• We recommend reading

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

Painkillers

Among the painkillers that are most often used to block joints are Novocaine, Lidocaine, Trimeacaine. After their administration, the pain syndrome is quickly relieved and the severity of the inflammatory process is reduced.

The advantage of such drugs is that they directly affect the focus of the pathological process. Negative reactions practically do not develop, since the drugs are not absorbed into the systemic bloodstream and into the digestive system. In addition to eliminating pain, such remedies reduce the severity of muscle tension, relieve vascular spasm and swelling.

Side effects of the drug Diprospan

As with the use of other corticosteroids, side effects are determined by the dose and duration of use of the drug. These reactions are usually reversible and can be reduced by reducing the dose (which is preferable to stopping the drug). From the side of water and electrolyte balance: hypernatremia, increased potassium excretion, hypokalemic alkalosis, increased calcium excretion, fluid retention in the body. From the cardiovascular system: congestive heart failure in predisposed patients, hypertension (arterial hypertension). From the musculoskeletal system: muscle weakness, myopathy, decrease in muscle mass, worsening of symptoms in myasthenia gravis, osteoporosis, aseptic necrosis of the femoral or humeral head, long bone fractures, tendon ruptures, joint instability (after repeated injections). From the digestive system: erosive and ulcerative lesions of the gastrointestinal tract with possible subsequent perforation and bleeding, pancreatitis, flatulence, esophageal ulcers. Dermatological: impaired wound healing, skin atrophy, thinning of the skin, petechiae and ecchymoses, erythema of the facial skin, increased sweating, dermatitis, skin rash, angioedema. From the nervous system: convulsions, increased intracranial pressure with papilledema (usually upon completion of treatment), dizziness, headache. From the endocrine system: menstrual irregularities, development of the Cushingoid constitution, intrauterine growth retardation of the fetus or child growth, impaired glucose tolerance, manifestations of latent diabetes mellitus, increased need for insulin or oral hypoglycemic agents. Ophthalmologic: posterior subcapsular cataract, increased intraocular pressure, glaucoma, exophthalmos. Metabolism: negative nitrogen balance (due to protein catabolism). Psychoneurological disorders: euphoria, mood changes, depression (with severe psychotic reactions), increased irritability, insomnia. Other manifestations: hypersensitivity reactions, including anaphylactic shock. Other adverse reactions associated with parenteral administration of the drug: isolated cases of visual impairment with intralesional administration in the face and head, hyper- or hypopigmentation of the skin, atrophy of the skin and subcutaneous fat, sterile abscesses, flushing of the face after injection (intra-articular administration) and neurogenic arthropathy.

Block of the knee joint with Diprospan

The key active ingredient in the drug is betamethasone. This drug is used in the treatment of many joint pathologies. After administration, the result is felt within 3-4 hours. The duration of action is one month. When injecting, it is not necessary to numb the injection area.

Diprospan is not only a powerful, effective analgesic and anti-inflammatory agent, it is also a safe drug that can rarely provoke adverse reactions. When used correctly, the medicine is safe for the body.

Novocaine blockade of the knee

Novocaine blockade is an innovative method that is used to treat various pathological processes in the joint apparatus. The mechanism of action is that the active substances of the drug temporarily stop the innervation processes in the diseased joint. The medicine is given by injection directly into the affected tissue that surrounds the joint or nerve.

This is a local anesthetic, its effect is manifested only when administered locally. The result comes within a short period of time. The pain is eliminated for an hour.

Novocaine works according to the following principle:

• the drug is an antiseptic and bacteriostatic, inhibits the growth and development of pathogens;
• increases the body's resistance to allergens;
• reduces the permeability of vascular walls;
• evens out vascular tone;
• quickly relieves spasms in smooth muscles;
• improves trophism in nerve fibers.

Novocaine actively affects the autonomic nervous system. Adverse reactions after administration of the drug are minimal. This is a safe remedy that quickly relieves pain and reduces the likelihood of developing negative consequences of the inflammatory process.

The key indications for novocaine blockade are:

• painful sensations, regardless of nature and location, that cannot be relieved by other means;
• acute inflammatory processes in soft tissues;
• injuries or damage to various groups of joints;
• burns, frostbite, snake bites;
• decreased tone of internal organs.

The use of blockade for the treatment of the cervical and lumbar spine

If you have already tried all possible methods of pain relief, but the pain still does not subside, you can try a blockade. Blockade is a procedure for relieving muscle spasms through a one-time injection of painkillers (novocaine, lidocaine) into the nerve plexus. The effect of the drug on the plexus is short-lived, but has a quick and noticeable effect, as it reduces the tone of the muscles cramped by spasms and improves the patient’s well-being for a long time.

The blockade procedure can be prescribed for such back pathologies as: osteochondrosis, osteoporosis, spinal hernia, radiculitis, during the treatment of chronic diseases of the spine, as well as for neuritis, myositis, sympathalgia and other diseases of the musculoskeletal system.

Positive aspects of this method:

• Fast and effective pain relief through the action of the drug directly on nerve clusters and endings.
• Quite a small number of side effects, since the painkiller first enters the pathological area, and only then into the general circulatory system.

Multiple blockades are allowed.

The blockade relieves the source of pain, providing an antispasmodic, anti-edematous and anti-inflammatory effect, improving metabolic processes in inflamed tissues. The use of novocaine and lidocaine during blockade gives an anesthetic effect, corticosteroids have an anti-inflammatory effect, and to achieve a longer therapeutic effect, mixed preparations are used.

Novocaine blockade

Novocaine injection is administered directly to the site of the most intense pain. As a rule, these are trigger points in tense muscles or sore joints, back pain, or points on nerve endings and clusters.

The therapeutic effect after a novocaine blockade lasts only up to half an hour, but this time is quite enough to bring the inflamed muscles to normal tone. After treatment, the patient experiences a decrease in pain, relief from spasm throughout the affected muscle, and an increase in motor activity in the joint.

Contraindications for novocaine blockade:

• heart pathologies (weakness of the sinus node, atrial block of the 2nd and 3rd degrees, bradycardia);
• arterial hypotension;
• allergic reactions to novocaine;
• epilepsy;
• myasthenia gravis;
• liver diseases.

Main types of blockades:

• vagosympathetic blockades of the chest are used for traumatic injuries of the chest, surgical interventions on the chest organs, for the treatment of lungs and pleuropulmonary shock;
• paravertebral blockade is prescribed for fractured ribs and diseases of the spine: radiculitis, osteochondrosis, spondylosis, etc.;
• intercostal blockade is used for rib fractures, especially multiple ones, and intercostal neuralgia;
• epidural blockade is used in the clinical form of radiculitis, multiple lesions of the lumbosacral nerve roots, and can also be used as anesthesia during gynecological operations, childbirth and caesarean section;
• conduction blockade is prescribed for a therapeutic effect in patients with chronic pain syndrome from neuralgia, herniated intervertebral discs, etc.

Techniques for performing a blockade in the cervical spine

Vagosympathetic blockade. The patient lies on his back, with a small cushion placed under his neck. The hand on the blockade side is pulled down strongly, and the head turns in the opposite direction. The doctor moves the sternocleidomastoid muscle upward and inward, and injects with a long needle slightly below or above the intersection of the muscle with the external jugular vein. The needle is moved inward and toward the front, taking into account the direction of the anterior surface of the spine. For blockade, use 0.25% novocaine solution 40-50 ml.

Paravertebral blockade. The patient lies on his stomach, his head is moved in the opposite direction from the blockade. The injection needle is inserted perpendicular to the skin closer to the outer edge of the extensor muscle of the back. Next, it is advanced until it touches the transverse process or damaged vertebra, and then shifted 0.5-1.0 cm to the side. The remaining injections are carried out, shifting them 1.5 cm from the previous one. For this blockade, a 0.25% solution is used, in an amount of 70-100 ml. Sometimes a mixture of novocaine and hydrocortisone can be used, where 50-75 mg of hydrocortisone is taken and adjusted to 100 ml with novocaine.

Techniques for performing blockade in the lumbar and sacral spine

First method. The patient lies on his stomach. The doctor uses palpation to find the point of greatest pain. As a rule, this is a projection onto the site of the lesion. The site of the procedure is treated with an antiseptic drug and a novocaine solution is injected into the skin with a thin needle until the so-called “lemon peel” is formed.

To block the cord, another needle is used, much longer than the first, inserting it with a lateral displacement of 3-4 cm from the spinous processes into the pathological intervertebral space. The needle penetrates all the way into the process and through it, as it is inserted, an anesthetic drug is constantly injected. Then the needle is partially pulled out and directed under the transverse process, but no further than 2.0 cm from it. At each level of the vertebral segment, 5 ml of solution is injected.

Depending on the size of the pain site, and, consequently, the pathological change in the vertebra, the blockade is placed at three points (between the lumbar vertebrae and the sacral region) or a funicular block can be used, using six points, three parallel to each other.

Second method. A distinctive feature of the method is the needle insertion technique. It is inserted above the spinous process of the pathologically damaged vertebra or closer to the outer edge. A “lemon peel” is made superficially, then a long needle is inserted, moving inward along the surface of the process, constantly feeling the needle sliding along the bone. Throughout the progress, the solution is constantly introduced.

The needle is guided until it reaches the vertebral arch, then it moves closer to the midline of the body (but not more than 1.5 cm), moves slightly outward and another 10-15 ml of the drug is injected. The solution penetrates into the deep muscles of the lower back, the periosteum, anesthetizing the corresponding cords.

The use of blockade in the treatment of spinal hernia

Novocaine blockade is widely used in the treatment of herniated intervertebral discs. Often the procedure is carried out with the addition of corticosteroid drugs, which allows you to quickly relieve pain, relieve muscle spasms, relieve swelling and pinched nerve endings.

In most cases, relief is observed almost instantly after the procedure and lasts up to twenty days, after which the blockade can be repeated. The course of treatment includes 3-4 novocaine procedures, as well as massages, physiotherapy, exercise therapy, manual therapy and osteopathy.

Intercostal blockade. The patient can sit standing or sitting. The needle passes in the direction of the rib, rests on it, then slides along it to the place where the nerve endings accumulate. Depending on the location of the procedure, blockade is distinguished: anterior, posterior, lateral, parasternal. For injection, a 0.25% novocaine solution of 10-15 ml is used, or to achieve maximum effect, 1.0 ml of alcohol (96%) can be added; or take novocaine 0.5%, but inject 5.0 ml. As the procedure progresses (needle insertion), the integrity of the vessels is constantly monitored.

Epidural block. It is carried out by introducing anesthetic drugs into the epidural space. The epidural space is a gap between the periosteum and the dura mating, filled with loose tissue, surrounding nerves and large venous collections. These spaces pass in the sacral region, and along the entire spinal canal there are epidural spaces. Both spaces are connected by constrictions. Novocaine, administered epidurally, separates the constrictions and freely enters the epidural cracks. Therefore, with repeated blockades, the anesthetic solution spreads more easily throughout the lumbar region.

When carrying out the procedure, care should be taken, since the dural sacs are located in the sacral canal, and their lower edge is in close proximity to the sacral foramen. Inserting the needle a little deeper than necessary increases the risk of novocaine getting into the subarachnoid zone, which can cause complications. To determine the entry point into the sacral foramen, the sacral horns are used, which are located on the side of it and can be easily felt under the skin.

When performing a blockade, the patient lies on his side (preferably on the side where pain is observed), bending his knees and pulling them towards his stomach. Before the procedure, it is necessary to isolate the anus using sterile swabs and napkins. Then the required area of ​​skin is treated with an antiseptic solution and the opening of the entrance to the sacral canal is determined.

Using a thin needle, novocaine is injected into the skin, creating local anesthesia (lemon peel). Then a longer needle is used to penetrate the skin and membrane covering the sacral opening. Then the direction of movement is changed - moving the needle down, almost horizontally, inserting the needle no more than 5 cm from the surface.

When carrying out the procedure, the doctor must control the process of needle passage by retracting the syringe piston. If clear fluid (spinal fluid) appears in the syringe, the blockade is stopped and a second attempt is made only after a day. When visualizing blood in the syringe, the blockade is continued by slightly returning and changing the direction of the needle.

If the movement of the syringe was successful, slowly inject the novocaine solution. For manipulation, use a 0.25-0.5% solution of 30-60 ml. In some cases, with novocaine, it is possible to administer a 5% solution of vitamin B1 (thiamine) and a 0.0005% solution of vitamin B12 (cyanocobalamin).

For epidural blockades, the addition of corticosteroids and hydrocortisone to novocaine has been successfully used, which can relieve swelling and inflammation of nerve endings and provide a longer-lasting effect.

After performing the blockade, the patient should spend at least 30-40 minutes in a supine position on the pathological side, preferably with the head of the block elevated.

The preparation of solutions for blockades and methods for their implementation are widely described in medical reference books and manuals, but the procedure must be carried out by a specialist (neurologist or neurosurgeon).
Otherwise, there is a danger of damage to muscle tissue or nerve processes, which can cause an absolute loss of motor activity. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Knee block with lidocaine

Lidocaine is a local anesthetic. It provides a longer and more intense effect than other types of painkillers. Used in the form of hydrochloride. After administration, voltage-gated sodium channels are blocked. As a result, the generation of impulses in neurons stops and innervation is blocked.

With the help of Lidocaine, pain is eliminated and the walls of blood vessels dilate. 5 minutes after the blockade, the pain stops and the muscles relax. This is a low-toxic drug, so the likelihood of developing negative reactions in the body is minimal.

Periarticular block of the knee joint

This is a treatment method that is used to relieve acute pain during the development of joint diseases. The main indications for the procedure are:

• neuritis;
• bursitis;
• osteoarthritis;
• periatrosis;
• arthritis;
• gonarthrosis;
• sprain.

With the help of this procedure, pain is eliminated, the local inflammatory reaction is relieved, and joint mobility is restored. The technique is that the injection is injected into the soft tissues without penetrating into the joint cavity.

Indications for use of the drug Diprospan

• Rheumatoid arthritis, osteoarthritis, bursitis, tenosynovitis, tendonitis, peritendinitis, ankylosing spondylitis, epicondylitis, sciatica, coccydynia, sciatica, lumbago, torticollis, ganglion cyst, exostosis, fasciitis, foot disease, bursitis due to hard callus, spurs, stiffness of the big toe .
• Asthma, status asthmaticus, hay fever, allergic bronchitis, allergic rhinitis, drug allergies, serum sickness, reactions to insect bites.
• Atopic dermatitis (coin-shaped eczema), neurodermatitis, contact dermatitis, severe solar dermatitis, urticaria, lichen planus, insulin lipodystrophy, alopecia areata, discoid erythematous lupus, psoriasis, keloid scars, pemphigus vulgaris, herpetic dermatitis, cystic acne.
• Systemic erythematous lupus, scleroderma, dermatomyositis, periarteritis nodosa.
• Palliative therapy of leukemia and lymphomas in adults; acute leukemia in children.
• Adrenogenital syndrome, ulcerative colitis, regional ileitis, sprue; pathological changes in the blood requiring corticosteroid therapy, nephritis, nephrotic syndrome.
• Primary and secondary insufficiency of the adrenal cortex (with mandatory simultaneous administration of mineralocorticoids).

Contraindications

A knee joint block is not prescribed in the following cases:

• blood fluid clotting disorder;
• epilepsy;
• individual intolerance to the constituent substances in the drugs;
• neuropsychiatric disorders;
• children under 12 years old;
• cellulitis or abscesses in the damaged area;
• peritonitis in the abdominal cavity;
• stable arterial hypertension;
• period of bearing a child;
• allergic reactions to injected drugs.

It is very important to consider the conditions under which the blockade cannot be carried out. Otherwise, the procedure is fraught with the development of negative reactions. When used correctly, this technique can reduce the risk of complications.

How to do a blockade for leg pain

For treatment, doctors use the following methods:

• Blockade of the knee joint with diprospan is used to relieve inflammation in synovitis, bursitis and arthritis. Valid for up to several days.
• Dexamethasone injection - prescribed for moderate symptoms. The action lasts up to 3-5 days.
• Injection of Kenalog and Lidocaine - the effect occurs in 15-20 minutes, and has a prolonged effect of up to 2-3 weeks.
• Novocaine blockade only relieves pain and does not affect the inflammatory process. Sometimes novocaine solution is replaced with lidocaine or trimecaine.

The administration of the drug is always carried out after preliminary anesthesia. Success depends on the professional skills of the doctor, as well as the stage of development of the disease.

Make an appointment with a doctor
After the procedure, the patient is recommended to:

• Avoid physical activity for 5-7 days;
• Do not wet or stain the injection site;
• Follow all recommendations of your attending physician.

You can find out the price of drug blockade or injections for arthrosis of the knee joint, read reviews and make an appointment directly on our website.