Constant pain in the joints and spine can make life very difficult for anyone. Medical blockades will help you quickly get rid of this scourge.
Most often, blockades are used as part of a comprehensive treatment of the disease: they are combined with manual therapy, physiotherapy, massage and other therapeutic courses. Injections of special drugs or their combinations are also used as an independent method of treatment. Blockades help relieve inflammation and swelling, and therefore pain. Drug blockades have anesthetic, antispasmodic, anti-inflammatory and thrombolytic properties.
How the procedure is performed:
First of all, a neurologist identifies a problematic source of pain in the patient, treats the skin with a disinfectant solution and injects a special drug that eliminates inflammation and pain. In each individual case, the course of therapeutic blockades and medications are prescribed individually.
Doctors often use novocaine, lidocaine, diprospan, dexamethasone, chondroguard and plasma. Injections of these drugs often relieve pain after just 1 session. But to achieve a sustainable therapeutic effect, blockades are used as part of complex therapy, which can only be selected by a neurologist after an examination. If the patient is bothered by acute pain in the joints and spine, then the blockade is performed at the initial consultation. The positive effect lasts for several days, and sometimes more than a month. Depending on the disease and symptoms, a course of 2-10 injections is required.
Zubov Evgeniy Valerievich, neurosurgeon Back pain significantly complicates a person’s life and limits motor activity. Any attempt to perform any movement can result in increased pain. The lumbar-sacral region, which bears the heaviest load, suffers especially often from vertebral pathologies. To eliminate acute and shooting pain in the lower back, various treatment methods are used. Paravertebral blockade is considered one of the fastest-acting. This is the injection of certain medicinal mixtures into the affected area in order to quickly “turn off” the pain syndrome.
Paravertebral blockade is a collective concept. The term “paravertebral” means one that is performed in close proximity to the spinal column. For lumbosacral pain, the injection is administered into the most painful area near the exit of the nerve endings. This makes it possible to stop a pain attack, increase nerve nutrition, and relieve swelling. In addition to the therapeutic purpose of numbing the affected area, paravertebral blockades have a preventive effect on concomitant pathologies. Chronic pain can cause muscle spasms and impair the functionality of spinal structures. The blockade prevents the progression of this process.
Advantages of paravertebral blockade: high efficiency and rapid action; close proximity of the injection to the lesion; minimum side effects; if the pain worsens, the procedure can be repeated; complex effect on the problem area (painkiller, antispasmodic, decongestant, anti-inflammatory).
Paravertebral blockade of the lumbosacral region is necessary for rapid pain relief in the following diseases: osteochondrosis; protrusion and intervertebral hernia; neuralgia; spondyloarthrosis; myositis.
Usually blockades are done for degenerative-dystrophic processes in the spinal column. Manipulations are carried out strictly according to the indications of a specialist. Each specific case will have its own treatment regimen and its own list of drugs to be administered. In some cases, one injection is enough to get rid of pain for a long time. Sometimes it is necessary to take a course of at least 2 injections with a break of 4-5 days.
Depending on the number of drugs used for manipulation, blockades are: 1-component (1 drug); 2-component (2 medications); multicomponent (more than 3). Pain relief is carried out using a blockade using different groups of drugs.
Anesthetics.
They are used both for single-component blockades and with the use of other medications. Acting on nerve fibers, anesthetics “turn off” the pain syndrome, delaying nerve impulses. Drugs: Novocaine - used more often than others. Novocaine begins to act within 2-3 minutes after the blockade. The analgesic effect lasts up to 2 hours. Lidocaine - has a rapid anesthetic effect that lasts for 2-3 hours. Merkain - the drug begins to act 10-20 minutes after administration. The therapeutic effect is longer compared to Novocaine and Lidocaine (3-5 hours).
Corticosteroids.
They are considered potent drugs. They have a pronounced anti-inflammatory and analgesic effect. Quickly relieve swelling in the injection area. Hormonal drugs are used for unbearable pain that is not relieved by conventional analgesics. Medicines are practically not used independently, but are administered simultaneously with anesthetics to enhance the therapeutic effect and prevent the development of an allergic reaction. Effective corticosteroids for blockade: Hydrocortisone; Dexamethasone; Diprospan.
Technique.
Since the injection is administered into the spine area, the procedure must be performed by a specialist. Any mistake can cost the patient's health. In most cases, paravertebral blocks are performed by a neurologist or neurosurgeon. The lumbosacral blockade is carried out in a specific area of the skin, muscles and other structures. The medicine or mixture of drugs is injected into a specific point where the pain is more acute. Stage 1 of the blockade is preparatory. You need to lie on your stomach. The doctor probes the most painful place. The skin around the intended injection site should be treated with an antiseptic (iodine or alcohol). Then, anesthesia is administered with several injections of a thin needle on the right and left sides of certain areas of the spinal column at the source of pain. Stage 2 – the paravertebral blockade procedure itself.
Paravertebral blockade is one of the fastest and most effective methods for eliminating pain in spinal pathologies. This manipulation must be taken very seriously. Only an experienced specialist can carry out the blockade. If the technique of the procedure is violated or all contraindications are not taken into account, this can cause irreparable complications.
Advantages of therapeutic blockades:
- Fast and effective pain relief - relieving inflammation, swelling, muscle tension and vascular spasm.
- Weak drug load on the body - the drug is administered only to the affected area, so only a small amount enters the bloodstream.
- Special drugs (for example, plasma) not only relieve pain, but also have a therapeutic effect.
- Minimal side effects.
Instructions for use DIPROSPAN® (DIPROSPAN)
Diprospan® is administered intramuscularly (if systemic entry of GCS into the body is necessary) and directly into the affected soft tissues, for intra-articular, periarticular, intrasynovial, intradermal and intralesional administration.
The dosage regimen and route of administration are set individually, depending on the indications, severity of the disease and the patient’s response to treatment. The drug should be used in the minimum dose and for the shortest possible period.
The dose should be adjusted to obtain a satisfactory clinical effect. If a satisfactory clinical effect does not appear after a certain period of time, treatment with Diprospan® should be discontinued and other therapy should be started.
IM injection
For systemic therapy, the initial dose of Diprospan® in most cases is 1-2 ml. The administration is repeated if necessary, depending on the patient’s condition. The drug is injected deep intramuscularly into the gluteal region.
In severe conditions (systemic lupus erythematosus and status asthmaticus),
requiring emergency treatment, the initial dose of the drug may be 2 ml.
For dermatological diseases
the dose is usually 1 ml.
For diseases of the respiratory system
The effect of the drug begins within a few hours after the intramuscular injection of Diprospan®.
For bronchial asthma, hay fever, allergic bronchitis and allergic rhinitis
a significant improvement in the condition is achieved after administration in a dose of 1-2 ml.
For acute and chronic bursitis
the initial dose for intramuscular administration is 1-2 ml. If necessary, carry out several repeated injections.
Local administration
When administered locally, simultaneous use of a local anesthetic drug is necessary only in isolated cases. If simultaneous administration of a local anesthetic drug is desired, then use a 1% or 2% solution of procaine hydrochloride or lidocaine using dosage forms that do not contain parabens. The use of anesthetics that contain methylparaben, propylparaben, phenol and other similar substances is not permitted.
When using an anesthetic in combination with the drug Diprospan®, first draw the required dose of the drug into a syringe from the bottle, then draw the required amount of local anesthetic from the ampoule into the same syringe and shake for a short period of time.
For acute bursitis
(subdeltoid, subscapularis, ulnar and prepatellar) the introduction of 1-2 ml of Diprospan® into the synovial bursa can relieve pain and completely restore mobility within several hours.
For the treatment of chronic bursitis
the drug is used in smaller doses after stopping an acute attack of the disease.
For acute tendosynovitis, tendonitis and peritendinitis
one injection of the drug Diprospan® alleviates the patient’s condition; for
chronic conditions
the injection of the drug should be repeated depending on the reaction. It is necessary to avoid injecting the drug directly into the tendon.
For rheumatoid arthritis and osteoarthritis
intra-articular administration of the drug in a dose of 0.5-2 ml reduces pain, tenderness and stiffness of the joints within 2-4 hours after administration. The duration of the therapeutic effect of the drug varies significantly and can be 4 weeks or more.
Recommended doses of the drug when administered to large joints
make up 1-2 ml;
medium -
0.5-1 ml;
in small ones
- 0.25-0.5 ml.
For some skin diseases
the drug is administered intradermally directly into the lesion at a dose of 0.2 ml/cm2. The lesion site is evenly pricked using a tuberculin syringe and a needle, which has a diameter of approximately 0.9 mm. The total dose of the drug administered to all injection sites within 1 week should not exceed 1 ml.
Recommended single doses of Diprospan® (with intervals between injections of 1 week) for hard calluses are 0.25-0.5 ml (usually 2 injections are effective); with a spur - 0.5 ml; for stiffness of the big toe - 0.5 ml; for a synovial cyst - from 0.25 to 0.5 ml; for tenosynovitis - 0.5 ml; for acute gouty arthritis - from 0.5 to 1 ml. For administration, it is recommended to use a tuberculin syringe with a needle that has a diameter of approximately 1 mm.
After achieving a therapeutic effect, the maintenance dose is selected by gradually reducing the initial dose by reducing the concentration of betamethasone in the solution, which is administered at appropriate time intervals. The dose reduction is continued until the minimum effective dose is reached.
If a stressful situation occurs or is threatened (which is not related to the disease), an increase in the dose of the drug may be required.
Discontinuation of the drug after long-term therapy should be carried out by gradually reducing the dose. The patient's condition is monitored for at least a year after completion of long-term therapy or after using the drug in high doses.
ADVANTAGES OF THERAPEUTIC BLOCKS IN THE CLINIC NAMED AFTER N.I. PIROGOV IN ST. PETERSBURG
- Appointments are conducted by doctors with extensive experience, authors of scientific papers and patents. Our specialists accurately diagnose neurological diseases, are fluent in modern and traditional therapeutic techniques, and select the optimal treatment tactics for each patient;
- The clinic is equipped with modern equipment from leading foreign companies;
- The Pain Treatment Department regularly holds promotions and offers discounts.
Therapeutic blockades are an effective means of relieving pain! Make an appointment
General precautions
Certain precautions must be taken into account before spinal injections are administered:
- If a patient regularly takes platelet-inhibiting medications such as aspirin or NSAIDs (nonsteroidal anti-inflammatory drugs), then they are at increased risk of bleeding and may not be a candidate for a spinal injection.
- If the patient is hypersensitive or has certain allergies to medications, adverse reactions to the medications used in the injection may occur. The patient must provide the doctor with a list of all allergies.
- If a patient has an underlying medical condition, they should discuss the risks of spinal injections with their doctor. For example, patients with diabetes may experience an increase in blood sugar levels after a cortisone injection. Patients with congestive heart failure, kidney failure, hypertension, or heart disease may experience problems due to fluid retention effects several days after the injection.