Novocain blockade: lumbar spine, joints, nerve, ear

To get rid of acute and chronic pain in clinical medicine, locally targeted injections of novocaine (an amino ester for local anesthesia) - novocaine blockade - are used.

After introduction of novocaine into the zone immediately adjacent to the focus of pain, its peripheral innervation - due to blocking of a number of receptors located in the membrane of neuronal cells of peripheral nerves - is disconnected. And, thus, the transmission of the afferent pain signal of the sympathetic nervous system to the central nervous system stops at a certain time.

Anesthetic procedure can be a part of anti-shock measures in emergency cases. And for those who experience severe prolonged pain, novocaine blockade of the nerve is part of the treatment, since antibiotics and other necessary medicinal substances can be added to the solution of novocaine.

[1], [2], [3], [4], [5]

Indications for the procedure

Novocain blockade is used for therapeutic, diagnostic or preventive purposes. The most frequent indications for this procedure:

• for relief of pain after various injuries;
• with acute visceral pain syndrome, associated with pathologies of internal organs;
• with partial injuries of large nerves accompanied by burning pain (causalgia);
• with neurogenic pains with limited mobility of the joints;
• in cases of contractory pain in muscles and ligaments (myofascial pain syndrome);
• as a puncture regional anesthesia when it is necessary to use invasive diagnostic methods (in urology and gynecology).

A novocain blockade is performed for bone fractures, in particular, for fracture of the ribs, for anesthesia when correcting complex dislocation of the joints.

Novocaine blockades are prescribed for neuralgia (neuropathies, neuritis) - lesions of peripheral nerves or nerve plexuses of the VNS of various genesis. And for the anesthesia of traumas of the auricles, their burn or frostbite, a novocaine blockade of the ear can be carried out.

Neurology, orthopedics and traumatology use periarticular blockades - novocain blockades of joints. Thus, novocain blockades of the knee joint completely relieve pain in traumatic injuries of its ligaments and meniscus rupture, with rheumatoid arthritis, gonarthrosis or inflammation of periarticular tissues (periarthritis).

In acute pain in patients with arthrosis, periarthritis of the shoulder joint or its trauma (for example, a fracture of the condyle), a novocaine blockade of the shoulder is prescribed.

Intercostal novocaine blockade is performed not only with fracture of the ribs, but also with pronounced intercostal neuralgia (developing due to  intervertebral hernia, osteochondrosis, kyphosis of thoracic spine or neuritis with herpes zoster).

Sometimes only this procedure helps with spasmodic pain syndrome of the intestines, kidneys or bile ducts. For example, when with strong pain in the ureter caused by the exit of stones, antispasmodics do not help, a new-cell blockade is necessary in case of urolithiasis.

Treatment of pain with novocaine in combination with corticosteroids, which remove inflammation and swelling of tissues, provides a guaranteed therapeutic effect, therefore, for various chronic inflammations with pain, a novocaine blockade with dexamethasone, betamethasone or prednisolone is carried out.

If severe pain occurs in the development of infections in the subcutaneous soft tissues (phlegmon, carbuncle, hydradenitis, fasciitis, etc.), a so-called short Novocaine blockade with antibiotics is used: the solution is injected into the skin around the inflammation focus.

Longer analgesic effect with intense pains provides spirituonokainovaya blockade (a solution of novocaine with medical alcohol). It is this solution that is used to blockade the sternum or ribs; Novocain blockade of the trigeminal nerve (and its branches) - with trigeminal neuralgia (accompanied by sharp shooting pains) or neuritis (with persistent pains of blunt character); Novocaine blockade of the coccyx (with its osteochondrosis or sciatica nerve), and with such a disease of female genitalia, as vulva vulgaris.

[6], [7], [8], [9], [10]

Technique of the novocaine blockade

Keep in mind that a new-cell blockade at home is not performed: it is a sterile procedure that is usually performed on an outpatient basis by a qualified specialist - trauma surgeon, orthopedist, neurologist with additional qualifications in the field of anesthesiology (rather than any manipulative nurse doing conventional injections) .

The technique of carrying out the Novocaine blockade by any method is worked out at the level of step-by-step actions - on the basis of surgical anatomy and topography of peripheral innervation of the human body and zones of nerve plexuses: the progress of the needle is controlled and corrected according to anatomical landmarks. And only a doctor who knows these techniques and has sufficient experience is allowed to perform such manipulations.

So, according to the descriptions, which lead many medical resources on the Internet, they will not help the patient to master the technique of carrying out the Novocaine blockade ...

Preparation for the procedure is a preliminary (for a day or two before the blockade) determination of the patient's sensitivity to novocaine - by administering a small dose under the skin.

The kit for Novocaine blockade includes: Novocaine solution (0.25-0.5%), sterile syringes (20 ml), special long and short needles. According to the type of manipulation, the needle can be of different sizes (18-26G) - with a less pointed end or a modified shape of its cut.

Considering the fact that the blockade is carried out with a pain syndrome, the appearance of an impressive size of needles in patients raises a logical question: is it painful to make a Novocain blockade? With a low pain threshold, any manipulation seems very painful, but an analgesic blockade can indeed be accompanied by a temporary increase in the pain syndrome. Although a small dose of a less concentrated novocaine solution is injected into the skin at the injection site with a fine needle before the introduction of novocaine with a long needle to reduce the painfulness of the procedure, until a zone of insensitivity to pain forms.

The main types of Novocain blockades

So far, the types of Novocain blockades do not have strict classification based on unified principles, therefore synonymy of the definitions is noted - depending on the place of the focus of pain and topography of the anatomical area of novocaine administration. In addition, the existence of a number of authoring techniques, which are reflected in the names, also leads to terminological duplication.

Novocaine can be administered intradermally (intradermally), subcutaneously, intramuscularly and intraosseously. The perineural injection of novocaine (into the perineural fibrous nerve trunk region) or the paraneural (in the surrounding tissues) is essentially a novocaine blockade of the nerve or a conductive novocain blockade, the essence of which is the cessation of nerve impulses. And if there are novocain blockades of joints, the injections are done either periarticularly (near the joint) or intraperiarticularly (inside the joint and surrounding tissues).

There is also a case-lined perivascular or case Novocaine blockade according to Vishnevsky, which is carried out by introducing an anesthetic solution into the connective tissue membranes (cases) of the muscles. It is done with a fracture of the hip and other tubular bones, as well as patients with trophic ulcers of the lower extremities. In almost the same cases, a blockade of the cross section or a circular Novocaine blockade is used - when the creation of the analgesic block is achieved by several intradermal injections in the same plane along the circumference of the limb.

This manipulation is also divided into species at the site of administration and subject to the action of novocain to the anatomical regions. Thus, the paravertebral paravertebral novocain blockade is characterized by the introduction of an anesthetic into the muscles next to the spine, that is, near the paravertebral ganglia of the sympathetic nerve trunk of the spine. In some medical sources, the root (funikulyarnaya) Novocaine blockade of the spine is allocated. But in any case, indications for its use are pains in the spine, when a novocaine blockade is prescribed with a hernia or protrusion of intervertebral discs, a Novocain blockade with radiculitis, spine trauma, lumbar osteochondrosis, etc.

The introduction of novocaine into adipose tissue near the kidney - a paranephric neocaine blockade according to Vishnevsky (with the addition of glucose in the solution) or a lumbar Novocaine blockade (according to Roman) - has an effect on the entire space behind the peritoneum and promotes the coping of intense spasmodic pain in patients with renal colic, acute inflammation gallbladder or pancreas, intestinal obstruction.

If the anesthetic solution is injected into the anterior-lateral surface of the neck (closer to the spine), that is, where the cervical section of the vagosympathetic trunk is located (and the vagus nerve and carotid artery are located nearby), then a vagosympathetic novocain blockade is performed-a cervical vagosympathetic block or cervical . In this case, the vagus nerve and the stellate ganglion are blocked in the neck. It is used for cervical osteochondrosis, posterior cervical sympathetic syndrome, as well as lesions localized in the thoracic region.

Pain syndrome in acute forms of cholecystitis and pancreatitis can remove the preperitoneal novocain blockade or else the novocaine blockade of the circular ligament of the liver, which extends longitudinally along the left groove in the lower part of the liver surface (to the left of the navel) and contains nerve fibers.

In traumatology, in any fractures of pelvic bones causing intolerable pain, an obligatory procedure is one or two-sided intracellular Novocain blockade according to Shkolnikov-Selivanov - with the introduction of an anesthetic (from the front of the trunk) deep (up to 12 cm) into the ileal region, near the anterior superior bone protrusion. Since there is a ureter in the area of Novocaine, this kind of Novocaine blockade can be used for renal colic associated with nephrolithiasis.

Presacral novocaine blockade is carried out in the region of plexus sacralis - sacral nerve plexus or through the sacrococcygeal ligament in the lower part of the sacrum (in the perineum between the sacrum and anus); it has an effect on the femoral-genital nerve and the coccygeal plexus. Proctologists can resort to such a method of removing acute and chronic  anal pain, with infringement of hemorrhoids, proctitis. This blockade facilitates the condition of patients with uterine bending, pathologies of uterine-sacral ligaments, ulcerative colitis, after surgical interventions on the perineum, the anus and genitals.

With intense pain due to sciatica-  sciatica nerve inflammation extending from the waist to the foot, or in cases of its entrapment, a novocaine blockade of the sciatic nerve (often with corticosteroids) is appointed: paraneurally into the sciatic nerve region with three possible accesses - posterior, lateral or anterior.

Neurologists note that sciatica can provoke squeezing of the sciatic nerve with an inflamed pear-shaped muscle (located under the gluteal and securing the mobility of the sacroiliac joint). In addition, pain in the buttocks with recoil in the groin of the hip and even the shin are obvious signs of the tunnel pain syndrome of the pear-shaped muscle, which often arises in the lumbosacral radiculitis with squeezing of the spinal roots. In such cases, a novocaine block of the pear-shaped muscle is assigned to the sciatic nerve region or by paravertebral blockade in the lumbar region (as with radiculitis).

Obligatory novocain blockade in the groin (in the inguinal ligament) with damage to the scrotum, testicles and their tubules, which can lead to painful shock, as well as in case of  torsion of the testicle.

Novokainovaya blockade of the spermatic cord, which is in the inguinal canal in men and through which the nerve fibers pass - the same as Novocain blockade according to Lorin-Epstein. Such manipulation is performed only for men - in case of acute inflammation the epididymis epididymis or seminal cord (funiculitis), as well as the acute form of orchitis (inflammation of the testicles).

The retrobulbar novelocaine blockade, with the introduction of the drug into the tissue layer in the orbit, is performed by ophthalmologists with neuritis of the optic nerve, keratitis, and trauma to the cornea.

And in otolaryngology, occasionally - with heavily flowing vasomotor rhinitis or sinusitis - novocain blockades in the nose (more precisely, into the wall of the nasal concha) can be applied with the addition of corticosteroids that quickly remove the swelling of the nasal passages and paranasal sinuses.

In addition, in abdominal surgery, a novocain blockade of the root of the small intestine mesentery is used during laparotomy intervention in acute intestinal obstruction. And the revision of the abdominal cavity during surgery for damage to her organs is also preceded by injections of novocaine into the roots of the mesenteric mesentery, transverse-colon and sigmoid colon.

Novocain blockade in veterinary medicine

Due to its effectiveness, this analgesic-therapeutic manipulation has found application in the treatment of animals, for which veterinary techniques have been modified or developed.

For example, suprap pleoral Novocaine blockade according to Mosin is used to anesthetize organs located in the abdominal cavity and pelvic region, and according to Shakurov's method - with pleurisy and pneumonia.

Cows and goats with inflammation or udder abscess make a NovaQainic blockade according to Logvinov, the same procedure is done and the procedure for a dog with mastitis.

Novaikinovaja blockade on Fateevu blocks pelvic nerve plexuses in cows, and this is done both in case of acute mastitis, and with problems with the uterus during and after calving. And with inflammation and trauma of the cornea, veterinarians conduct a retrobulbar blockade used in humans.

Contraindications to the procedure

To carry out the Novocaine blockade there are such contraindications as:

• individual hypersensitivity to novocaine or its intolerance;
• terminal condition of the patient;
• abscesses, peritonitis, septicemia;
• bleeding;
• increased hemorrhage, hemorrhagic and hypocoagulation syndrome;
• fever and fever;
• persistent arterial hypotension;
• myelitis of any etiology;
• presence of multiple sclerosis and other demyelinating diseases;
• inoperable malignant tumors;
• severe cardiovascular insufficiency with ventricular arrhythmia;
• mental disorders;
• age up to 12 years.

Included in the list of contra-indications is Novocaine blockade during pregnancy and during lactation.

[11], [12], [13], [14], [15]

Complications after the procedure

Each patient reacts to this procedure in its own way: in some, the analgesic effect of the Novocaine blockade manifests itself at once, in others the pain temporarily increases, some pain relief comes after the second or third blockade, since local anesthesia lasts for a relatively short time.

Complaints of patients for temporary numbness after a novocaine blockade, which takes place during the first 18-20 hours, as well as internal heat at the injection site and a feeling of bursting, are related to the specific effects of novocaine on the axons of nerve cells, and also pass quickly.

However, it is necessary to take into account possible complications after the procedure. First, side effects of novocaine may be manifested - in the form of general weakness, dizziness, lowering blood pressure, or skin rashes allergic.

Secondly, the negative consequences after the procedure is fraught with:

• non-compliance with the technique of its conduct, leading to a violation of the integrity of blood vessels, nerves and their branches, nerve plexuses, parenchyma of visceral organs, intestinal walls;
• infection due to insufficient level of asepsis;
• increased dose of the drug.

In the latter case, the patient first has increased anxiety and nervous excitement (with the appearance of convulsions, increased breathing), which goes into the depression of the central nervous system, a decrease in heart rate and respiration, and loss of consciousness. And getting a significant amount of novocain in the systemic bloodstream can lead to cardiac arrest.

The high efficiency of the correct Novocain blockade proved decades of application in clinical practice, and the relief from pain positively affects not only the condition of patients, but also the results of treatment with other drugs and methods.

[16], [17], [18], [19], [20]

Care after the procedure

Special care after the procedure is not required: the doctor observes the condition of the rest after the patient's manipulation (from half an hour for two hours). If the patient is walking and does not undergo treatment in the hospital, he returns home after an hour and a half after the blockade, and after a day of rest and some restriction in nutrition (with the exception of heavy food) can start his usual activities and eat in the usual way. But here to consume alcohol after novocaine blockade is contraindicated for at least a week.

[21], [22], [23]