Therapeutic blockade of Neurology - Causes, Symptoms and Treatment .MF .
Since the most common cause of treatment of patients to the doctor is a pain, and the doctor's task is not only to establish its cause, but also eliminate the pain, and if possible, do it as quickly as possible.There are many ways to treat pain:. Medical, physiotherapy, massage, manual therapy, acupuncture and other
One method of treating pain in medical practice neurologist is a medical blockade.
method of therapeutic blockades is the youngest in comparison with others - medication, surgical, psychotherapeutic and numerous physical therapies such as massage, acupuncture, chiropractic therapy, traction, etc.
anesthetic blockade, breaking the vicious circle. Pain - musclespasm - pain, have a marked effect on the pathogenetic pain.
Therapeutic blockade - a modern method of treatment of pain and other clinical manifestations of the disease, based on the introduction of drugs directly into the pathological center, responsible for the formation of a painful syndrome.Compared with other methods (. Medic
The main objective of the embargo - as far as possible to eliminate the cause of the pain.But the important point is the struggle with the pain.This struggle must be carried out quickly, with the fewest side effects, expensive and time consuming.In other words quickly and efficiently.It meets these conditions blockades method.
There are several variants of closures.
This local and segmental blockade.
Local blockade made directly to the affected area, in the area of the modified tissue reactions by lesions or around them, where there is inflammation, scar and so on. They can be periarticular (in periarticular tissues) and perineural (in channels, where thenerves).
By segmental include paravertebral blockade, ie,in the projection of certain segments of the spine.Option a segmental therapy has an explanation.Each segment of the spine and spinal nerves corresponds to a certain area of the skin, connective tissue (called dermatitis), muscle (myotome) and certain "segment" of the skeletal system (sclerotome).In the segment is switched nerve fibers, so it is possible and crosstalk.Acting via intradermal injection of drug in a particular dermatome can influence how the corresponding segment of the spine, and the condition of internal organs innervated by that segment of the spinal cord, achieving a therapeutic effect.Conversely, when diseases of internal organs in a particular segment of the corresponding dermatome lesion or myotomy occur.In accordance with the same mechanism by means of influence on myotome sclerotome or therapeutic effect can be achieved in relation to the internal organs.
What drugs are used for the blockade?Mostly it's local anesthetics (procaine, lidocaine, and others.) And steroids (diprospan, Kenalog, etc..), The application of cardiovascular drugs.Drugs differ in duration effect, the level of toxicity, efficacy, mechanism of action.Only a doctor can determine whether the blockade in this case shows how the drug and which option is preferable to the blockade.
What are the advantages of the method of therapeutic blockades?
- Fast analgesic effect
Fast analgesic effect blockades due to the fact that the anesthetic directly reduces elevated impulses mainly by slow conductors of the nervous system, which is distributed and chronic pain.With other methods (electroneurostimulation, acupuncture, and other physical factors) are stimulated mainly the fast nerve conductors that reflexively and indirectly inhibits pain impulses, so the analgesic effect develops slowly.
- Minimal side effects
When medical methods (pills, or intramuscular injection) drugs first enter the bloodstream (where they are not needed) and then, to a lesser extent - to the painful center.When the blockade same drugs are delivered directly into the pathological focus (where they are most needed), and then a smaller amount coming into the general circulation.
- Possibility reusable
course, anesthetic blockade temporarily interrupts the pain, pathological impulses, keeping other normal nerve impulses.However, the time, but multiple block pain impulses from pathological focus allows for severity and duration of therapeutic effect.Therefore, therapeutic blockade can be used multiple times, with each exacerbation.
- Complex therapeutic effects
addition to the main advantages (rapid analgesia, minimal toxic effects) therapeutic blockade have a number of therapeutic effects.They take a long time local pathological muscle tension and vascular spasm, inflammatory reaction, edema.They restore impaired trophism local tissue.Therapeutic blockade, stopping pain impulses from pathological focus, lead to the normalization of relations between the reflex at all levels of the central nervous system.
Thus, therapeutic blockade are pathogenetic method of treatment of the clinical manifestations of a number of diseases and pain syndromes.The experience of therapeutic blockades said that therapeutic blockade is one of the most effective treatments for pain.
However, we must remember that therapeutic blockade, as well as any other method of treatment, especially injection, fraught with the risk of some complications, has its indications, contraindications and side effects.
doctors Years of experience and a lot of experience of other hospitals shows that complications from the blockades toxic, allergic, traumatic, inflammatory and other nature occur no more frequently than from conventional intramuscular and intravenous injections.Highly qualified doctors clinic reduces the risk of complications from therapeutic blockades to a minimum.
But in any case, the need for the appointment of this type of treatment is determined by the doctor only.
Indications primenenib therapeutic blockades
The main indication for the use of the method of therapeutic blockades is pain due to an osteochondrosis of the cervical, thoracic and lumbar spine, arthralgia, neuralgia, facial pain, headache vertebro-vistseralgii, postoperative and phantom pains, plexopathy,. complex regional pain syndrome and other blockade Treatment also apply to the syndrome Meniere, myotonic syndrome, venous limb disorders tunnel syndrome and other
anesthetic blockade are streamed same method of diagnosis ex juvantibus -. assessment of the effectiveness of the blockade, as a rule, it has provided substantial assistancedoctor correct diagnosis allows more fully imagine the ways of formation of the pain syndrome, to identify the sources of its production.
when planning therapeutic interventions using therapeutic blockades exploring possible sources of pain.It is based on violations of various anatomical structures of the spinal motion segment:
• intervertebral disc
• posterior longitudinal ligament
• epidural vessels
• spinal nerves
spinal cord • facet joints
• muscles, bones
innervationthese structures at the expense of return (nerve Lyushka) and the posterior branch of spinal nerve.And return, and the back branches carry information, which later spread over the sensitive portions of the nerve root in the centripetal direction.
Accordingly innervation of the spinal segment may define pathological impulses interrupt level by blocking the nerve branches.From this perspective, the blockade are divided into several groups:
1.Blokady in the zone of innervation of the posterior branch of spinal nerve
• paravertebral blocks of muscles, ligaments, intra
• para-articular facet joint blockade
• paravertebral blockade posterior branches of the spinal nerves throughout
2.blockade in the area of the return branch of the spinal nerve
• intradiscal injection
• selective blockade of spinal nerve
3.Otdelnuyu group consists blockade myotonic tense limbs.
Therapeutic effect blockades caused by several mechanisms:
• pharmacological properties of anesthetic drugs and related
• reflex action at all levels of the nervous system •
effect maximum drug concentration in the pathological focus, etc.
!!!.The main mechanism of the therapeutic effect of the anesthetic blockade is a specific property to temporarily suppress the excitability of the receptors and the conduction of impulses along the nerves.
anesthetic penetrates the biological environment to the nerve fibers, adsorbed on their surface by interaction with the polar groups fosfoproteidov phospholipids and is fixed to the membrane receptor and / or the conductor.Anesthetic molecules incorporated into the structure of proteins and lipid membranes, enter into competitive reaction with calcium ions and disrupt the interchange of sodium and potassium, which inhibits sodium transport through the membrane and the occurrence of blocking in the receptor field and conduct it along the nerve fiber.
extent of the anesthetic at the nerve fiber depends on one hand on the physicochemical properties of the anesthetic, the other - the type of nerve conductor.The anesthetic has predominant influence on those conductors, where it binds to a large area of the membrane, ie the first blocks unmyelinated, slow fibers - pain and autonomic Guides, then myelin conducting epicritic pain and the least - motor fibers.
for blocking the conduction of excitation along the myelin fibers necessary effects of the anesthetic, at least 3 node of Ranvier, as jitters can be transmitted through 2 of interception.
Selective effects of the anesthetic on the slow conductors creates the conditions for the normalization of relations afferentation pain for slow and fast fibers.
!!!According to the modern theory of "gating control pain" at the segmental level there is the main regulation of nociceptive afferent, which is the main mechanism that suppresses irritation of fast-twitch fibers afferentation by slow - "closes the door."
prevails holding irritation at the slow fibers, which facilitates afferentation In pathological conditions - "opens the gates" and formed a painful syndrome.
influence this process in two ways:
1.stimulirovat mostly fast fiber - using percutaneous electroneurostimulation
2.ugnetat predominantly slow - the use of a local anesthetic.
In terms of pathology more physiologic and preferred is a second way - by a preferential inhibition of afferent fibers slow that not only reduces pain afferentation, but also to normalize the relationship between the afferent flows on slow and fast conductors on a more optimal physiological level.
!!!Medlennoprovodyaschie predominant influence on the fiber can be achieved by introducing multiple low anesthetic concentration in tissue.
Acting mainly on unmyelinated slow conductors anesthetic blocks not only pain afferents, but unmyelinated efferents - primarily autonomic fibers.Therefore, the duration of the anesthetic, and long after the complete removal of it from the body reduces abnormal autonomic reactions such as vasospasm, trophism disorders, swelling and inflammation.Normalization of afferent flows at the segmental level, resulting in restoration of normal reflex activity and at all higher levels of the central nervous system.
big role in achieving the therapeutic effect of the blockade are the following factors:
1.pravilny selection of the concentration of a local anesthetic sufficient to block unmyelinated and insufficient to block myelin fibers
2. From precision summing receptor or nerve agents anestetia solution (closerthe conductor will be delivered to the anesthetic, the less it will dilute interstitial fluid, the lower the initial concentration of anesthetic will be sufficient to perform the blockade quality, the lower the risk of toxic complications)
!!!From this perspective, the blockade must be essentially "sniper shots, that is, therapeutic blockade must comply with the principle -" where it hurts - go there if "
When the therapeutic blockade marked characteristic, three-phase change in pain:
1) first.phase - the aggravation of "recognizable pain," which is caused by mechanical stimulation painful area receptors with the introduction of the first portions of the solution (the duration of the phase corresponds to the latent period of anesthetic)
2) The second phase - anesthesia, when under the influence of the anesthetic the pain is reduced to a minimum level - an average of25% of baseline pain (duration of this phase corresponds to the anesthetic duration of action in the painful area)
3) the third phase - the therapeutic effect, when after the end of the anesthetic and removing it from the body's pain renewed, but an average of 50% from baselinepain (duration of this phase can be from several hours to several days)
encouraged not to elaborate on the issues mentioned above, on the application of the blockade as a diagnostic sredstva.Tselyu diagnosis is to identify the painful areas palpation which causes pain provocation.Typically, in various pain syndromes, there are several such zones and often conventional diagnostic methods can be quite difficult to determine the main focus of pathological irritation.
In this case, you should focus on the effectiveness of therapeutic blockades.In such a situation before a doctor is an alternative task:
• or carry out infiltration of multiple tender points?
• or block one the most painful?
In the first case - in the blockade of several weak points therapeutic dose of drugs to be distributed to several points in the most important and the concentration zone will be insufficient, in addition, simultaneous absorption of drugs from several points increases their toxicity.In this case, the diagnostic value of such manipulation decreases as the block a few sore spots does not allow to identify the most relevant, taking advantage of the participation in the formation of a specific pain and prevents further purposeful work on the most current zone.
In the second case - the one block most painful area allows tissue to reach its maximum concentration of drugs and to minimize the possibility of toxic reactions.Naturally, this option is preferable.At the same pain several points, their alternate block is used.On the first day blockade produces one point, as a rule, more proximal, and observe the change in pain during the day.If the drug solution introduced into the actual painful area, it usually occurs in a patient phenomenon of "recognized pain", and further, pain regresses not only the point at which the held block, but also in other points of the disease.If the phenomenon of "recognizable pain" after the first blockade and therapeutic effect were expressed not enough, following the blockade it is necessary to make another painful area.