Drug blockade of the cervical vertebrae of the sympathetic trunk along with the vagus nerve is called "vagosympathetic blockade". It was prescribed by Alexander Alexandrovich Vishnevsky with the intention of interrupting nerve impulses during pleuropulmonary shock due to traumatic disorders and injuries of the chest area.
It gives a stable positive result in diseases of an inflammatory nature and various ailments of muscle tone.
S. G. Zohrabyan experienced cervical novocaine blockade in order to recognize hypotensive syndrome of traumatic origin. Observations were made of an experimental brain injury in which blockade of the cervical sympathetic nodes in animals with cerebral hypotension can lead to an increase in intracranial pressure for a short time. Headache is reduced in 80% of cases after this procedure. But the result lasted only a couple of hours. This is because the blockade temporarily relieves spasm of cerebral vessels, resulting in improved blood supply to the brain.
What is the procedure based on?
Vagosympathetic blockade is a method of non-standard pathogenetic treatment based on:
- At a short stop in peripheral nerve patency.
- On the reaction of an unenriched solution of novocaine to the signaling functions of the central nervous system (CNS).
Blockade Benefits
According to these provisions A. Vishnevsky came to some conclusions:
- For various reasons, the process of inflammation at the beginning of its growth obeys the same laws.
- The growth of the inflammation process can be suspended while it is at the stage of serous tissue impregnation.
- A severe form of inflammation is very quickly limited, suppurates and resolves, and a weakly passing one is detected.
- Infiltrative, non-acute and other chronic forms of inflammation are expressed by trophic shifts, sometimes quickly resolved.
- Diseases associated with a pathological change in the work of organs. A slight irritation of the nervous system, which is carried out by cervical vagosympathetic blockade, removes an organ from an altered state. At the same time, blockade in such processes affects multifunctionally: resolves spasm, restores work with paresis.
- The processes of a pathological nature, which are caused by a change in work and the passage of capillaries, the novocaine blockade directs to correct the physiological position of the vascular wall.
What types of blockages exist?
Consider this issue in more detail. The main types of blockades:
- Blockade of the fracture site of long tubular bones.
- Case block of the shoulder.
- Case block of the lower leg.
- Blockade of the cross section.
- Blockade of the femoral nerve.
- The sciatic nerve.
- Tibial nerve.
- Fibular nerve.
- Intercostal conductor blockade.
- Paravertebral block.
- And of course, cervical vagosympathetic.
Vagosympathetic block: indications
Indications of the cervical vagosympathetic blockade are also:
- Pleuropulmonary shock.
- Numerous rib fractures.
- Open, closed and valve accumulations.
- Burns of the respiratory tract.
- Postoperative pneumonia.
- Syndromes of traumatic asphyxiation.
- Syndromes of fatty obstruction (pulmonary form).
Most often, it is when these pathologies occur that the procedure is performed.
In order for vagosympathetic blockage to be carried out according to the Vishnevsky method, it is necessary to know the axo-anatomical connections of the sympathetic trunk and vagus nerve. These neoplasms are located above the hyoid bone, in the same cellular area, which gives an explanation of the likelihood of synchronous blockage when novocaine is introduced here. Below they are divided by the parietal leaf of the fourth fascia.
Patient preparation
Before the blockade begins, the doctor examines the inscription on the vial or ampoule with the anesthetic. The patient must always be in a supine position, because due to the action of anesthesia the appearance of various complications is not excluded. Before surgery, the skin is always treated with an antiseptic solution. The blockade also requires this. Processing must be carried out without fail, since pathogens must not be allowed to enter the puncture site.
After that, the area of the skin must be covered with sterile linen.
What happens next?
The patient is laid on his back, while under the shoulder blades, a roller is placed. The head is turned in the opposite direction from the blockade. The patient’s hand is pulled down from the blockade. 1-2 ml of a 0.25-5% anesthetic solution are injected under the skin along the posterior border of the right sternocleidomastoid muscle, about 1-1.5 cm above its center. If the shape of the jugular vein is not visible, then the injection site is predetermined by the level of the upper edge of the thyroid epiglottis.
How exactly is a vagosympathetic blockade carried out?
The technique is unique, it is carried out only by highly qualified specialists. The index finger of the free hand muscles and blood vessels are displaced inward and feel the initial surface of the cervical vertebrae. Then, at the end of the finger, a large needle is inserted and it is moved inward, towards the initial surface of the vertebrae. In the process of introducing the needle in a small volume of 2-3 ml, an anesthetic solution is added to anesthetize the procedure. After the end of the needle has touched the vertebrae, an aspiration test is done (performed to avoid intravascular administration of the anesthetic). After making sure that the blood is not drawn into the syringe, 30-60 ml of a 0.25% anesthetic solution is slowly injected. Then the needle is pulled out, and the injection site is pressed with a sterilizing gauze swab for 1-2 minutes.
If you strictly observe and follow the rules for vagosympathetic blockade, an anesthetic solution fixes the vagus nerve and other nerves that depart from the cervical nodes of the sympathetic trunk.
Symptoms after the procedure
An effective vagosympathetic blockade in a patient causes the following symptoms:
- Ptosis (omission of the upper eyelid).
- Miosis (narrowing of the pupil).
- Enophthalmos (inward eyeballs; Horner triad).
- Redness of the face and mucous membranes of the eyes.
- Pericorneal injection of blood vessels.
- Reduced perspiration from the blockade.
Cervical vagosympathetic blockade according to Vishnevsky prevents pain, cough reflex, tones the circulatory system and increases blood pressure.
The blockade cannot be done from two sides at once. The time interval between procedures should be at least 30-40 minutes. Also, during the procedure, you can not add adrenaline to the anesthetic solution.
What caused such restrictions? The fact is that you can accidentally achieve respiratory paralysis due to blockade.
Complications
After carrying out, complications can also arise:
- Violation of the carotid artery during piercing.
- Violation of the internal jugular vein.
- Violation of the esophagus.
The likelihood of developing atony and paresis of the intestine (such complications do not require special treatment).
All this can provoke a cervical vagosympathetic blockade according to Vishnevsky. Indications to her, we reviewed.
Alternative
Another intervention on parts of the neck requires access, that is, dissection of each layer of the skin. To access the neck, it is necessary to maintain hygiene, as this is an open part of the body. Because of this, lateral access along Kocher along the transverse folds of the skin is used on the neck. Sutures after surgery in this case are usually invisible. When performing surgery on parts of the neck with a longitudinal location, a longitudinal incision is often used along the front or rear edge of the sternocleidomastoid muscle. Seams are especially noticeable after a median longitudinal section. Vagosympathetic blockade (the technique is quite common) will help to avoid this operation.
You don’t have to joke with your health, you must follow safety precautions and do not lose vigilance. Then various unpleasant accidents can be avoided.