Pain syndrome is the main manifestation of the clinical picture of pathologies of the musculoskeletal system, in particular, the spine. The occurrence of acute vertebral pain should stop immediately, even taking into account the fact that the fight against pain is not an etiotropic therapy. Spinal blockade is one of the measures that takes place in the complex treatment of vertebrology problems.
General concepts
It is more difficult for specialists to stop chronic pain than acute back pain, as the manifestations begin to have a central character. That is, the focus of the manifestation of pain is formed not at the level of excitation of local receptors, but in the brain. Treatment of this condition is longer and requires the use of antidepressants and antipsychotics.
To prevent this, symptomatic therapy already in the early stages of the disease uses such a manipulation as spinal blockade. What is it and how is the procedure carried out, we will consider further.
Blockade is the exclusion of a link from the mechanism of pain control, using medication analgesics. In addition to the therapeutic purpose, spinal blockade is used for diagnostics. The pain of unspecified localization requires the introduction of anesthetics, which allows the method of exception to determine the department of development of pathology. As a rule, the pain syndrome "turns off" instantly after the manipulation.
Indications
Diseases of the musculoskeletal system requiring the use of blockade must necessarily be accompanied by painful manifestations. In the opposite case, the use of medicines for this purpose is not relevant. The procedure is carried out with the following pathologies:
- osteochondrosis;
- the presence of a hernia of the intervertebral disc;
- deforming spondylosis;
- radiculopathy;
- traumatic injuries;
- neoplasms of the intervertebral space;
- lateral narrowing of the spinal canal.
The procedure is performed in cases where there is no effect of conservative treatment. Efficiency occurs after the first injection, however, severe forms of the disease require from 2-3 to 15 manipulations carried out at intervals of several days.
The advantages of the blockade are quick performance, a minimum of side effects, subject to the rules of the conduct, the possibility of reuse. In addition to analgesia, the manipulation has an anti-inflammatory and antispasmodic effect, which depends on the selected drugs.
Classification of Vertebral Blockade
Depending on the number of medications administered simultaneously, the following manipulations are distinguished:
- monocomponent (one remedy);
- components (two products);
- multicomponent (three or more means).
Painkillers are injected into the following anatomical departments:
- The spine - thoracic, cervical, lumbar, sacrum.
- Nerves - sciatic, occipital, tibial, suprascapular, posterior branches of the spinal nerves.
- Muscular apparatus - muscles of the head, piriformis, anterior scalene.
- Epidural and epidural spaces.
- Facet joints.
- Joints - sacroiliac and sacrococcygeal.
Blockade with a hernia of the spine are divided into two types:
- Transforaminal administration is characterized by injecting the drug into the exit openings of the nerve endings.
- In the intralaminar procedure, the medication is injected between the vertebral processes directly into the cartilage disk.
Contraindications
Blockade of the spine has certain contraindications, which the doctor takes into account when examining the patient. Each clinical case is considered individually, specifying the possible risk of side effects. The procedure is not performed under the following pathological conditions:
- diseases characterized by a tendency to bleeding;
- systemic infectious diseases and local manifestations in the field of puncture;
- unconsciousness of the patient;
- individual intolerance to the medicines used;
- heart and vascular diseases;
- epilepsy;
- arterial hypotension;
- Mental illness
- childhood;
- period of pregnancy and lactation;
- organic lesions of the liver and kidneys.
Local anesthetics
Substances that have an analgesic effect are used for all types of blockades, using the drug in its own form or in combination with other groups of medicines.
Novocainic blockade of the spine is carried out more often than other injections of anesthetics. "Novocaine" is available in the form of a solution for injection with different concentrations of the active substance (from 0.25% to 2%). The analgesic effect develops a few minutes after the blockade was carried out. An injection using Novocaine anesthetizes up to 2 hours.
"Markain" is also used to relieve pain. The result of the introduction of the drug has a late start. The pain disappears after 20 minutes, but the duration of action can reach 5-6 hours. The use of “Markain” is carried out only after a thorough examination of the patient’s heart and blood vessels.
The next local anesthetic used to combat vertebral pain is Lidocaine. The price of the drug is in a low category (about 30 rubles per package), which makes it available for use. The medication is characterized by a quick action and longer in time than Novocain.
Novocain and Lidocaine, the price of which is more than affordable, are used more often than other local anesthetics. Before using any of them, it is necessary to check the individual sensitivity of the patient in order to prevent the development of an allergic reaction.
Hormonal drugs
Hormonal preparations in the treatment of pathologies of the spinal column in the form of self-administration are extremely rare. Most often they are used to treat joints. Blockade of the spine requires a combination of corticosteroids with other drugs (e.g., anesthetics). Hormonal drugs reduce pain, stop inflammatory processes, reduce swelling and allergic manifestations.
Means used in vertebrology:
- Prednisolone is mixed with one of the analgesic drugs (Procaine, Lidocaine, Novocaine). It is effectively used for blockade with hernia of the spine, radiculitis, osteochondrosis.
- "Hydrocortisone" is used for nerve blockade. Thoroughly mixed with anesthetic before administration.
- Diprospan is used for any type of pain relief. The drug is good for the rapid development of the effect and prolonged action.
- Means "Kenalog", in addition to anti-allergic and anti-inflammatory, has an immunosuppressive effect. It is used for any kind of blockade and joint treatment.
Other groups of medicines
The rest of the drugs have no analgesic effect. They are used as part of multicomponent blockades and include the following drugs:
- non-steroidal anti-inflammatory ("Voltaren");
- B vitamins;
- enzymes ("Lidase", "Papain");
- ATF;
- antispasmodics ("Platifillin");
- "Thrombolysin";
- chondroprotectors ("Rumalon").
Procedure example
Consider the example of manipulation. Novocainic blockade of the lumbar spine is carried out in the supine position. Palpating the injection site, it is treated with an antiseptic solution. Using a thin needle, the drug is injected intradermally until a lemon peel forms.
Then the needle is replaced with a longer one and inserted between the necessary vertebrae a few centimeters lateral to the spinous processes. As the needle is inserted, a small amount of the solution is released portionwise. It is inserted all the way into the appendix. Then the needle is partially removed back and sent under the shoot no more than 2 cm. 5 ml of the solution is injected at the level of each segment of the spinal column.
A blockade of three main points is carried out: between the 4th and 5th lumbar vertebrae, between the 5th lumbar and 1st sacral, in the region of the 1st sacral opening. With severe pain, bilateral manipulation is carried out using six points. The procedure takes about 40 minutes of time. For several hours after anesthesia, the patient is under the supervision of specialists.
Epidural spinal block - what is it?
Epiduritis and lumbosacral radiculitis are indications for epidural administration of analgesic medications. When anesthetizing the lumbosacral spine, the patient is located on his side, bringing his legs bent at the knees to his stomach. The anus is isolated with sterile towels or sheets. The field is disinfected at the site of future drug administration.
In the projection of the lower sacral opening, the drug is administered intradermally. Then they change the needle and introduce it in parallel, piercing the membrane of the entrance to the sacral canal. Next, the needle goes down almost horizontally to a depth of not more than 5 cm, performing fluid control by pulling the piston over itself. In the absence of content, a drug is administered. The patient may feel pressure and fullness in the coccyx.
The maximum volume of drugs administered in one manipulation is 60 ml. Epidural blockade allows you to use:
- novocaine;
- cyanocobalamin;
- thiamine;
- corticosteroid drugs.
Possible complications
All types of anesthesia should be performed exclusively by a qualified specialist under sterile conditions. The blockade itself, the injection, the field treatment and all other parts of the procedure require strict adherence to asepsis. A neglect of the procedure can affect the patient’s health and lead to the development of the following complications after spinal blockade:
- bleeding due to damage to the integrity of blood vessels;
- severe pain at the injection site;
- respiratory failure when the product enters the subarachnoid space;
- allergic reactions;
- collapse;
- violation of the bladder;
- infection of the membranes of the spinal cord and puncture area;
- neurological reactions;
- damage to nerves, blood vessels, ligaments or the muscular system during an inaccurate procedure.
Conclusion
Blockade of the spine, reviews of which confirm a positive result of the procedure, is considered almost the only way out in the absence of the effectiveness of conservative therapy. Mandatory conditions for a favorable outcome are a thorough examination of the patient and strict adherence to the rules of aseptic and antiseptic during manipulation.