Advantages and disadvantages
For simple surgical interventions, local anesthesia is indispensable; it has advantages over other types of sensitivity suppression. The drug that is used, an anesthetic solution, acts strictly at the injection site, which helps to avoid severe complications and adverse reactions.
The blockade of pain sensitivity develops on average in 10-15 minutes. The effect lasts for an hour or more, so local anesthesia can reduce pain in the area of the postoperative wound. The patient’s consciousness does not suffer from the action of the local anesthetic, so after the manipulation he can leave the clinic and not be in the ward.
But local anesthesia has its drawbacks. Just a few years ago, it was widely used for operations on superficial tissues and extremities; methods for intravenous administration of drugs with simultaneous application of a tourniquet were developed. Intraosseous anesthesia was widely used. But due to the large number of adverse reactions and complications, these methods began to be used less frequently. And after receiving high-quality drugs for anesthesia, dangerous methods of pain relief were practically abandoned.
The disadvantage of the local method is its limited scope of application. It is effective for anesthesia of mucous membranes, skin and superficial tissues, but is not used for operations on the abdominal and pelvic organs, neck and head.
The infiltration type of local anesthesia cannot be used when operating on malignant tumors due to the possibility of tumor cells entering beyond the wound into other tissues. This increases the risk of developing metastases.
Medicines for injections against back and lower back pain
Why does pain occur?
Back pain appears from various diseases; only a doctor can determine the correct diagnosis and prescribe appropriate treatment.
The most common diagnoses:
- due to stress
- due to bone disease - osteoporosis
- due to damage to the spinal cord roots - radiculitis
- after a spinal injury
- damage to articular cartilage – osteochondrosis
- during the formation of an intervertebral hernia
What effect do back injections have?
Many people are afraid to get injections in the back and often refuse this method of treatment. In fact, this method is much more effective, because the injection relieves pain faster than pills, and injections can also stop the inflammatory process, which most often causes you to feel discomfort.
Doctors often prescribe NSAIDs or local anesthetics for injections; below we will look at their area of action, and analgesics and chondoprotectors can also be prescribed. Vitamins and immunomodulators are prescribed as an addition to medications.
We treat joints with NSAIDs
NSAIDs are nonsteroidal anti-inflammatory drugs that have dual effects. Unfortunately, they do not affect the cause of the disease itself, but relieve pain and reduce inflammation. The biggest disadvantage of treatment with such drugs is that most of them have a negative effect on the kidneys and digestive system. The first symptoms of a side effect from the medicine appear in the form of nausea and diarrhea. The reason for this effect is irritation of the intestinal and stomach mucosa with long-term use of NSAIDs.
However, such treatment is prescribed for the following diseases - radiculitis, hernia.
The most common NSAID drugs are:
Ketorol is an anti-inflammatory drug and is also used for pain relief. Has a high probability of side effects.
Diclofenac – Pain reliever.
Milgamma - B-vitamins with lidocaine. Has a neurotropic effect.
Movalis is a treatment for joints, with a reduced effect on the gastrointestinal tract.
Voltaren - has a large number of side effects, but provides long-term pain relief and relieves acute pain.
All these drugs are new generation drugs, but despite this, they should only be prescribed by the attending physician.
What are therapeutic blockades? When are they appointed?
For long-term, incessant back pain, doctors often prescribe therapeutic blockades, and they are also used for chronic pain. The injection is carried out directly into the point of pain or into a special area of the spine. They contain agents that, interacting with each other, increase the analgesic effect, namely novocaine and a steroid.
Chondoprotectors for osteochondrosis
Chondoprotectors are also a type of injection, but they are able to influence the cause of pain, unlike the previous ones.
Chondoprotectors are not able to help in treatment at a late stage, but if the cartilage is not destroyed, then these agents block its further destruction and nourish the cartilage tissue. It will take a long time to be treated with such drugs - about 1-1.5 years, but the result will definitely be there, although not immediately.
The following medications are called chondoprotectors: Alflutop, Rumalon, Hyaluronic acid. The most commonly used are Chondroitin sulfate and Glucosamine sulfate.
In any case, if you have back pain, contact a good specialist, since back treatment is a set of measures, in addition to medications, most likely you will be prescribed a set of physical activities; you cannot perform such activities on your own, as your condition may worsen.
Also, by consulting a doctor, there is a chance to avoid painful injections. People with a sedentary lifestyle, older people and those with sedentary jobs are at risk for spinal diseases. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr
Types of local anesthesia
Several types of local anesthesia are used in surgical practice, but some of them already have historical significance. The main methods of pain relief are the following:
- superficial anesthesia - pain sensitivity is suppressed after the anesthetic comes into contact with the surface of the tissue, most often used to anesthetize the mucous membranes. The anesthetic solution is applied by lubrication or irrigation, the effect lasts for 10 minutes;
- infiltration anesthesia - anesthesia by impregnation, or infiltration of tissue layers with a local anesthetic. The technique allows you to control the depth and width of the drug injection, depending on the intended incision. The medicine is injected carefully first into the subcutaneous area until the lemon peel effect appears, then the needle is gradually moved inward and an additional dose of the drug is injected;
- anesthesia according to Vishnevsky is an improved version of the infiltration method. A weak anesthetic solution is injected layer by layer under high pressure. A tight creeping infiltrate forms in the tissues. It spreads through the interfascial spaces and disrupts the conduction of impulses along the nerves passing through them. After cutting the wound, the liquid gradually flows out of the wound, so there is no risk of its absorption into the systemic circulation and the development of toxic reactions;
- conduction anesthesia is the essence of the method in anesthetizing a specific area of the body innervated by the nerve trunk. An anesthetic drug is injected into the tissue around the nerve; the technique is used for operations on the limbs;
- spinal anesthesia - the analgesic effect is achieved by injecting an anesthetic drug under the choroid of the spinal cord, the main place of drug administration is the lumbar region, and pain sensitivity in the pelvic organs and lower extremities disappears. But tactile sensitivity does not suffer;
- epidural anesthesia is a type of anesthesia in which a local anesthetic is injected into the space over the dura mater of the spinal cord, and a puncture is also performed in the lumbar region. Sensitivity is lost after 15-20 minutes, but the effect lasts for 3-4 hours. The use of this type of anesthesia allows you to resume activity early after surgery;
- bone anesthesia is a type of anesthesia in which an anesthetic solution is injected into spongy bone. Currently, it is practically not used; previously it was used for operations on the limbs.
Why are injections given into a vein?
If medications can be taken in the form of tablets or tasty syrups, why inject them into a vein? The fact is that not all medications, when taken orally (by mouth), act effectively and quickly. After the drug is absorbed in the intestine, it does not immediately reach the desired organ. It still has to pass through the liver, where part of it will inevitably be destroyed. In addition, the medicine is forced to “take a detour” through the body, and its effects will not appear immediately.
When administered intravenously, the active substance immediately enters the general bloodstream and, bypassing the liver, reaches the desired organ. Sometimes this is of fundamental importance.
Everyone is well aware of how the procedure goes. The nurse asks the patient to place his arm on the table, palm up, and applies a tourniquet above the elbow. You may be asked to “work with your hand” - clench your hand into a fist several times. Due to this, the veins fill with blood even more, swell, and are easier to get into with a needle.
The nurse inserts the needle and pulls the syringe plunger slightly onto the neck. If blood appears in the syringe, the needle has entered a vein. The tourniquet is removed and the medicine is administered. Many drugs must be administered slowly, otherwise unpleasant symptoms may occur.
The elbow is the most common site for intravenous injections. But some people have veins in this area that are “bad” or already “punctured”, and the whole skin is bruised. In such cases, the nurse may use another vein, for example, on the back of the wrist, in the ankle area.
Preparations for local anesthesia
Local anesthetics are drugs from the group of neurotropic drugs that completely or partially block the flow of signals along nerve fibers from the site of painful manipulation or surgery to the central parts of the nervous system.
The peculiarity of the action of drugs is related to their spectrum of action. They suppress the transmission of signals along myelinated type A nerve fibers, which transmit feelings of pain, smell, and temperature. Tactile sensations are carried out through type B fibers, and anesthetics do not affect them. Therefore, when using local anesthesia, the patient does not feel pain, but feels the touch of the doctor and the surgical instrument.
Local anesthetic drugs are divided into 3 groups depending on the duration of action:
- short-acting - the effect lasts 30-50 minutes, these include Novocain;
- average duration - up to 90 minutes, these are drugs Lidocaine, Trimecaine, Ultracaine;
- long-acting – the effect lasts more than 90 minutes, typical for Bupivacaine.
Local anesthetic drugs affect the electrochemical processes of ion exchange in nerve endings. Medicines work effectively in an alkaline environment and tissues rich in lipids, which include nerves. But the analgesic effect decreases with severe tissue inflammation, which is associated with a transition of pH to the acidic side.
The effect of local anesthetics is enhanced by drugs that affect vascular tone. Therefore, they are often combined with adrenaline to prolong the effect. This allows you to reduce the dose of pain medication and avoid toxic reactions.
What is operated under local anesthesia in mammology?
The mammary glands are located superficially, they do not have muscles and large nerve trunks. Breast tissue is loosely located; in young women, glandular tissue predominates, which is replaced by fatty tissue with age. Therefore, for numerous manipulations and operations, local anesthesia can be used.
In mammology, anesthesia is used to perform invasive diagnostics, which include breast tissue biopsy. To do this, a local anesthetic is injected with a thin needle into the area of the intended puncture. After 10-15 minutes, the doctor can take breast tissue for examination without fear of causing pain to the patient.
Local infiltration anesthesia in mammology is used for small, minimally invasive operations. A woman can undergo puncture of a breast cyst after preliminary infiltration anesthesia. A similar approach can be used when removing small benign breast tumors.
In men, anesthesia is used during surgery for type 1 gynecomastia, when the size of the gland is still small. Infiltration of tissues increases hydrostatic pressure in them, thanks to which the doctor can easily separate pathological tissues from healthy ones.
Is it painful to do local infiltration anesthesia?
When performing anesthesia, a standard disposable syringe with a thin needle is used. Whether local anesthesia is painful depends on your general pain threshold. The patient feels the moment of the first puncture of the skin and a slight feeling of fullness when the drug is administered. After the medication begins to act, sensitivity disappears. The doctor checks how effective the injection is by tapping the skin. In response, there is a feeling that the injection site has become woody.
After the end of anesthesia, sensitivity gradually increases, and a slight tingling sensation may appear. If anesthesia was performed for surgery, pain in the wound area begins to bother you, which can be reduced with the help of non-steroidal anti-inflammatory drugs.
Types of painkillers
Nonsteroidal anti-inflammatory drugs
- eliminate current pain and relieve inflammation, but do not help fight the causes of pain syndromes.
Corticosteroids
- slow down inflammatory processes at all stages, preventing the development of free radicals. They are derivatives of the natural human hormone – cortisol. Corticosteroids are injected directly into the specific area where the pain occurs.
Muscle relaxants
– reduce the sensitivity of nerve endings and weaken reflex reactions, which leads to a decrease in muscle tone and relieves pain.
The most effective or best pain-relieving injections in the treatment of back and lower back pain are considered:
- Diclofenac
- Ketanov
- Movalis
All these drugs belong to the group of non-steroidal anti-inflammatory drugs.
Contraindications for local anesthesia
Local infiltration anesthesia is a relatively safe method of pain relief. But to reduce risks during and after surgery, it is necessary to take into account contraindications to the use of the method. The main ones are the following:
- allergy to anesthetic - if earlier during dental treatment under local anesthesia an allergy to an anesthetic appeared, then during breast surgery the effect will repeat, and may be more pronounced, up to anaphylactic shock;
- psychomotor agitation and mental illness, reaction to the administration of an anesthetic and the surgical procedure itself can cause unpredictable behavior of the patient;
- during operations on malignant tumors - when infiltration anesthesia does not allow compliance with the ablastic rule;
- during long operations that require the use of microsurgical equipment;
- during interventions on areas of the body with a pronounced vascular network, for example, on the neck.
If local anesthesia is contraindicated, general anesthesia is preferred.