Epidural blockade

Epidural blockade is considered perhaps the most effective method of blocking pain in complicated herniated intervertebral discs. Moreover, for the use of such a productive technique, the specific location of the lesion does not have any special differences.

Due to the fact that even small hernias require complex treatment, which lasts quite a long time, patients often need pain relief during the peak of the exacerbation. Due to severe pain patient unable to start immediate therapy. First, you will need to eliminate unpleasant symptomatic manifestations, and only then provide assistance with a focus on eliminating the source of the problem.

Spend a intervention for spinal hernia is allowed only by neurologists or related doctors who have the proper skills and experience.

Features of manipulation

The main advantage of the method is its belonging to non-surgical options for influencing source of pain. Despite the outwardly apparent simplicity, it is still recommended to carry it out in a hospital after the patient has passed a series of preliminary analyses. They aim for exceptions possible, hidden contraindications, andprevention development any side effects, including those of an allergic nature, such as, for example, anaphylactic shock.

In principle, when using an epidural blockade, the occurrence of adverse reactions most often minor. The limited range of complications, if performed correctly, is explained by the fact that the active, anesthetic substance is injected directly into focus of pain. Only after this, the drug is absorbed into the blood, and not vice versa, as is the case when taking tablets or intramuscularor intravenous injections.

Manipulation is based on the ability of drugs to enter directly into the epidural area, which is not connected to the brain or spinal cord. But to achieve good performance, you will have to come to terms with the fact that the action, possibly, you will need to repeat, as the effect lasts for about a month.

And with severe pain in the lumbar region spine sometimes drugs do not cope with complete relief painful syndrome, only slightly weakening its manifestations. People complain that the procedure did not help. With such a development of the scenario, it is worth conducting the blockade again, because doctors repeated practice is allowed. Sometimes neurologists suggest other ways to resolve the issue, so it is important to listen to what is offered in your particular case.

When is it time to see a doctor?

Having figured out what an epidural blockade is, the townsfolk begin to look for alarming signs in themselves, indicating the need to carry it out. But the usual soreness in the back is not the only signal that indicates the need to apply this approach.

Between the vertebral bodies are discs that increase the stability of the spine to vertical loads and absorb mutual displacement of the vertebrae. Many factors play a role in the occurrence of a hernia. Most often, such a problem is faced by people who are engaged in physical labor or office workers.

In the first case, these are gravity, which can lead to a crack in the intervertebral discs, and in the second, a long position in one position, which leads to “starvation” of the discs. Discs weakened by herniation poorly fix the vertebrae along the physiological axis of the body, increasing the load on the muscles in this place. Muscles are quickly overloaded and pain appears. Due to overload, many muscle cells die, which further weakens the muscle corset. Edema develops in the affected area and this disrupts the blood supply, which means that the cartilage does not receive enough nutrition, decreases and dries out. Degenerative-dystrophic processes begin to develop, affecting, first of all, the fibrous ring. It quickly loses its ability to keep the intervertebral disc in its correct (anatomical) place, and it becomes more mobile. Modified discs no longer function normally, depreciation is lost, they begin to wear out, and in some cases crack. In the future, this leads to a rupture of the fibrous ring and the exit of part of the nucleus pulposus beyond its anatomically normal location – the formation of an intervertebral hernia occurs.

It will take a blockade can also topics to patientswho suffer from osteochondrosis. Such people are at increased risk, because it is this ailment that is basis for the emergence hernia. The disease contributes to destructive changes in the cartilaginous tissue of the intervertebral discs.

Classification of epidural blockade

The price of an anesthesia technique directly depends on what type it belongs to. According to their purpose, blockades are divided into diagnostic, prognostic and therapeutic. This method of administration is used for local anesthetics, as well as non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids.

To choose in favor of a certain category, the specialist must first study the complaints of the victim, his medical history, and the results of the tests. But, regardless of the decision made, it is necessary to introduce the composition in such a way as to maximize the effect on the lesion. The blockade will not cure the original source of the problem, but it will significantly improve the patient’s quality of life for the period of rehabilitation therapy.

The drugs used are divided into two groups: basic (basic) and additional. Due to the rapid onset of analgesic action as a basic tool for all types of blockades (diagnostic, prognostic and therapeutic), local anesthetics have found the greatest use. Unfortunately, the duration of their action is several tens of minutes. In addition, they do not have anti-inflammatory and anti-edematous activity, so they use the second group of additional drugs with these properties. These include hormonal agents (glucocorticoids).

Separately, the second group of pharmacological agents is administered very rarely, since it does not carry a direct analgesic effect. Together with the anesthetic, it turns out to achieve the perfect combination.

But trying to independently choose a set of drugs for yourself at home without prior consultation is a dangerous undertaking. With such amateur performance, the percentage probability of allergies increases at times. Also, attempts to alleviate well-being without medical recommendations greatly lubricate the clinical picture, or even cause additional trauma to the nerve endings.

Techniques for conducting

The mechanism of this manipulation is based on the rapid penetration of medicinal substances into the subarachnoid space through the dural couplings, which contributes to the formation of blockade and obstruction of impulses to the spinal cord along the radicular nerves. The introduction of drugs is carried out in the epidural zone using a catheter.

No special preparation before the epidural block is required. It can be applied to all parts of the spine: cervical, thoracic, lumbar, sacral.

The procedure itself is carried out in one of the following ways:

1. Intralaminar – when, with the introduction of the drug, the syringe needle is directed along the midline between the processes of the spine;
2. Transforaminal – when the injected drugs come from the intervertebral foramen to the exit of the spinal nerve.

Before the procedure, the doctor will definitely briefly talk about how anesthesia will pass, and will warn about the need to report the current state of health during the administration of medications.

The blockade is carried out for a rather long time, therefore, at least two hours after its completion, the patient should be under the supervision of medical personnel.

Usually, the intervention is not accompanied by significant discomfort, but sometimes you have to put up with manifestations of weakness and temporary numbness of the upper and lower extremities. This is quite a typical reaction of the body to anesthetics.

Schematically, the procedure looks like this:

• a person is laid on his side, bending his legs;
• knees bring to the stomach;
• disinfect the skin;
• probe the area of ​​uXNUMXbuXNUMXbthe probable location of the hernia;
• carry out anesthesia;
• make a hole.

For injection, a needle with a diameter of 60 mm is used.

Next, the doctor changes the course of the needle to reach the horizontal level, introducing to a depth of approximately 50 mm. To make sure the location is correct, doctor first, fluid is taken from the area where the needle is inserted. If the fluid has blood, then the needle is moved to move outside the blood vessel.

When cerebrospinal fluid appears in the syringe, the movement is stopped.

The implementation of the blockade itself is often accompanied by tangible discomfort, so the doctor will try to administer the drug as slowly as possible. In one visit, the introduction of 30 to 60 ml is allowed medicinal product.

To increase productivity, patients will have to lie down on the affected side for about forty minutes at the end of the manipulation. During this time, the victim may experience slight bleeding at the puncture site, but this is quite normal.

Contraindications for holding

The effectiveness of the technique has been proven in practice many times. But not all to patients she fits perfectly. To eliminate the risk of deterioration, doctor must take into account the presence of the sick specific contraindications. These include:

• destabilization of the cardiovascular system;
• heavy liver or kidney disease;
• disturbances in the functioning of the central nervous system;
• fever of unknown etiology;
• pregnancy.

Also, postpone such manipulation it will be necessary if a person has an infectious lesion of the skin in the area of ​​​​the intervention. We are talking about pustular formations, infected open wound surfaces, burns. The probability of complications of some chronic diseases is taken into account.

Risks of side effects

In most cases, the blockade gives positive results if carried out according to the rules. But, if it was performed in non-sterile conditions, with the wrong instruments, or an inept neurosurgeon supervised the process, then complications cannot be avoided.

Most often, complaints when complications occur come to burning and pain. This indicates that the drug has entered the blood vessel. With the most terrible development of the scenario, even anaphylactic shock is possible.

Collapse is much less common. The so-called reaction from the cardiovascular system, which characterized by loss of consciousness. This is more common when ignoring contraindications to carry out the blockade. To reduce the likelihood of such a development, the victim is pre-injected with caffeine or ephedrine approximately 15 minutes before the start of the procedure.

When the victim complains of severe headaches with shortness of breath, this signals the receipt of medications in the subarachnoid space. Very rarely, cases of needle piercing of internal organs located in the abdominal cavity are recorded.

To avoid all of the above, you need to carefully approach the choice of a clinic and a neurologist who will follow this procedure.. Also, do not assume that after stopping the pain, you can forget about the main treatment. Blockade only eliminates pain syndrome, but does not eliminate the source of the disease. You will have to prepare for a long struggle for your own health.