Novocaine blockade: lumbar spine, joints, nerve, ear

To relieve acute and chronic pain in clinical medicine, locally targeted injections of novocaine (an amino ether agent for local anesthesia) are used – novocaine blockade.

After the introduction of novocaine into the area directly adjacent to the source of pain, its peripheral innervation – due to the blocking of a number of receptors located in the membrane of neuronal cells of the peripheral nerves – is switched off. And, thus, the transmission of the afferent pain signal of the sympathetic nervous system to the central one stops for a certain time.

The pain-relieving procedure can be part of anti-shock measures in emergency cases. And for those who experience severe, long-term pain, a novocaine nerve block is part of the treatment, since antibiotics and other necessary drugs can be added to the novocaine solution.

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Indications for the procedure

Novocaine blockade is used for therapeutic, diagnostic or prophylactic purposes. The most common indications for this procedure are:

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

Novocaine blockade is performed for bone fractures, in particular, for rib fractures, for pain relief during reduction of complex joint dislocations.

Novocaine blockades are prescribed for neuralgia (neuropathies, neuritis) - lesions of the peripheral nerves or nerve plexuses of the VNS of various origins. And for pain relief of injuries to the auricles, their burns or frostbite, a novocaine blockade of the ear can be performed.

In neurology, orthopedics and traumatology, periarticular blockades are used - novocaine blockades of joints. Thus, novocaine blockades of the knee joint completely relieve pain in case of traumatic injuries of its ligaments and meniscus rupture, in case of rheumatoid arthritis, gonarthrosis or inflammation of periarticular tissues (periarthritis).

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

Intercostal novocaine block is performed not only in case of rib fractures, but also in case of severe intercostal neuralgia (developing due to intervertebral hernia, osteochondrosis, kyphosis of the thoracic spine or neuritis due to herpes zoster).

Sometimes only this procedure helps with spastic pain syndrome of the intestines, kidneys or bile ducts. For example, when antispasmodics do not help with severe pain in the ureter caused by the release of stones, a novocaine block is necessary for urolithiasis.

Treatment of pain syndrome with novocaine in combination with corticosteroids, which relieve inflammation and tissue swelling, provides a guaranteed therapeutic effect, therefore, for various chronic inflammations with pain, novocaine blockade with dexamethasone, betamethasone or prednisolone is performed.

If severe pain occurs due to the development of infections in the subcutaneous soft tissues (phlegmon, carbuncles, hidradenitis, fasciitis, etc.), a so-called short novocaine blockade with antibiotics is used: the solution is injected into the skin around the site of inflammation.

A longer analgesic effect in case of intense pain is provided by an alcohol-novocaine blockade (a solution of novocaine with medical alcohol). This solution is used to perform a blockade in case of fractures of the sternum or ribs; a novocaine blockade of the trigeminal nerve (and its branches) – in case of trigeminal neuralgia (accompanied by sharp shooting pains) or neuritis (with constant dull pains); a novocaine blockade of the coccyx (in case of its osteochondrosis or inflammation of the sciatic nerve), as well as in such a disease of the female genitalia as vulvar kraurosis.

Technique novocaine blockade

Please note that novocaine blockade is not performed at home: it is a sterile procedure that is usually performed on an outpatient basis by a qualified specialist - a trauma surgeon, orthopedist, neurologist with additional qualifications in the field of anesthesiology (and not just any manipulation nurse giving regular injections).

The technique of performing novocaine blockade by any method is worked out at the level of step-by-step actions - based on surgical anatomy and topography of the peripheral innervation of the human body and nerve plexus zones: the advancement of the needle is constantly monitored and adjusted according to anatomical landmarks. And only a doctor who knows these methods and has sufficient experience is allowed to perform such manipulations.

So, the descriptions provided by many medical Internet resources will not help the patient master the technique of performing a novocaine blockade...

Preparation for the procedure consists of preliminary (one or two days before the blockade) determination of the patient’s sensitivity to novocaine by injecting 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. Depending on the type of manipulation, the needle can be of different sizes (18-26G) - with a less sharp end or a modified shape of its cut.

Considering that the blockade is performed with pain syndrome, the sight of the impressive size of the needles in patients raises a logical question: is it painful to do a novocaine blockade? With a low pain threshold, any manipulation seems very painful, but an analgesic blockade can really be accompanied by a temporary increase in pain syndrome. Although to reduce the pain of the procedure, before introducing novocaine with a long needle into the skin, a small dose of a less concentrated novocaine solution is injected into the injection sites with a thin needle - until a zone of insensitivity to pain is formed.

Main types of novocaine blockades

Until now, the types of novocaine blockades have not been strictly classified based on uniform principles, therefore, synonymy of definitions is noted - depending on the location of the pain focus and the topography of the anatomical area of novocaine administration. In addition, the presence of a number of proprietary methods, which are reflected in the names, also leads to terminological duplication.

Novocaine can be administered intradermally (intradermally), subcutaneously, intramuscularly and intraosseously. Perineural administration of novocaine (into the area of the perineural fibrous sheath of the nerve trunk) or paraneural (into the tissues surrounding the nerve) is, in fact, a novocaine nerve block or conductive novocaine block, the essence of which is to stop the conduction of nerve impulses. And if novocaine blockades of joints are performed, then injections are made either periarticularly (near the joint) or intraperiarticularly (inside the joint and into the tissues surrounding it).

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

This manipulation is also divided into types by the injection site and the anatomical areas affected by novocaine. Thus, paravertebral - paravertebral novocaine blockade - is distinguished by the introduction of anesthetic into the muscles near the spine, that is, near the paravertebral ganglia of the sympathetic nerve trunk of the spine. Some medical sources distinguish radicular (funicular) novocaine blockade of the spine. But in any case, the indications for its use are pain in the spine, when novocaine blockade is prescribed for a hernia or protrusion of intervertebral discs, novocaine blockade for radiculitis, spinal column injuries, lumbar osteochondrosis, etc.

The introduction of novocaine into the fatty tissue around the kidney – paranephric novocaine block according to Vishnevsky (with the addition of glucose to the solution) or lumbar novocaine block (according to Roman) – has an effect on the entire space behind the peritoneum and helps relieve intense spastic pain in patients with renal colic, acute inflammation of the gallbladder or pancreas, and intestinal obstruction.

If the anesthetic solution is injected into the area of the anterolateral 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 pass nearby), then a vagosympathetic novocaine block is performed - a cervical vagosympathetic block or cervical. In this case, the vagus nerve and stellate ganglion in the neck area are blocked. It is used for cervical osteochondrosis, posterior cervical sympathetic syndrome, as well as injuries localized in the chest area.

Pain syndrome in acute forms of cholecystitis and pancreatitis can be relieved by preperitoneal novocaine blockade or otherwise - novocaine blockade of the round ligament of the liver, which runs longitudinally along the left groove in the lower part of the surface of the liver (to the left of the navel) and contains nerve fibers.

In traumatology, for any fractures of the pelvic bones that cause unbearable pain, a mandatory procedure is a unilateral or bilateral intrapelvic novocaine blockade according to Shkolnikov-Selivanov - with the introduction of an anesthetic (from the front of the body) deep (up to 12 cm) into the iliac region, near the anterior superior bone protrusion. Since the ureter is also in the zone of action of novocaine, this type of novocaine blockade can be used for renal colic associated with nephrolithiasis.

Presacral novocaine block is performed in the area of plexus sacralis – sacral nerve plexus or through the sacrococcygeal ligament in the lower part of the sacrum (into the perineum between the sacrum and the anus); it affects the genitofemoral nerve and coccygeal plexus. Proctologists can resort to this method of relieving acute and chronic anal pain, in case of strangulated hemorrhoids, proctitis. This block alleviates the condition of patients with uterine flexion, pathologies of the uterosacral ligaments, ulcerative colitis, after surgical interventions on the perineum, anal area and genitals.

In case of intense pain due to sciatica - inflammation of the sciatic nerve, which extends from the lower back to the foot, or in cases of its pinching, a novocaine blockade of the sciatic nerve is prescribed (often with corticosteroids): paraneurally in the area of the sciatic nerve with three possible approaches - posterior, lateral or anterior.

Neurologists note that sciatica can be provoked by compression of the sciatic nerve by the inflamed piriformis muscle (located under the gluteal muscle and providing mobility of the sacroiliac joint). In addition, pain in the buttocks area radiating to the groin, thigh, and even shin are clear signs of tunnel pain syndrome of the piriformis muscle, which often occurs with lumbosacral radiculitis with compression of the spinal roots. In such cases, a novocaine blockade of the piriformis muscle is prescribed - in the area of the sciatic nerve or by paravertebral blockade in the lumbar region (as with radiculitis).

A novocaine blockade in the groin area (in the inguinal ligament area) is mandatory in case of damage to the scrotum, testicles and their tubules, which can lead to pain shock, as well as in the case of testicular torsion.

Novocaine blockade of the spermatic cord, which is located in the inguinal canal in men and through which nerve fibers pass, is the same as the Lorin-Epstein novocaine blockade. Such manipulation is performed only on men - in case of acute inflammation of the epididymis (epididymitis) or spermatic cord (funiculitis), as well as acute orchitis (testicular inflammation).

Retrobulbar novocaine blockade with the introduction of the drug into the layer of tissue located in the eye socket is performed by ophthalmologists for neuritis of the optic nerve, keratitis, and corneal injuries.

And in otolaryngology, occasionally - in cases of severe vasomotor rhinitis or sinusitis - novocaine blockades in the nose (more precisely in the wall of the nasal turbinates) can be used with the addition of corticosteroids, which quickly relieve swelling of the nasal passages and paranasal sinuses.

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

Novocaine blockade in veterinary medicine

Due to its effectiveness, this analgesic-therapeutic manipulation has also found application in the treatment of animals, for which existing methods have been modified or their own methods have been developed in veterinary medicine.

For example, suprapleural novocaine block according to Mosin is used to anesthetize organs located in the abdominal cavity and pelvic area, and according to Shakurov’s method – for pleurisy and pneumonia.

For cows and goats with inflammation or abscess of the udder, a novocaine block is performed according to Logvinov; the same method is used for the procedure for dogs with mastitis.

Novocaine blockade according to Fateev blocks the pelvic nerve plexuses in cows, and this is done both in cases of acute mastitis and in cases of problems with the uterus during and after calving. And in cases of inflammation and trauma to the cornea of the eye, veterinarians perform a retrobulbar blockade, which is used in humans.

Contraindications to the procedure

There are the following contraindications for performing novocaine blockade:

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

Novocaine blockade is included in the list of contraindications during pregnancy and lactation.

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Complications after the procedure

Each patient reacts to this procedure in their own way: for some, the analgesic effect of the novocaine blockade manifests itself immediately, for others, the pain temporarily increases, and for some, pain relief comes after the second or third blockade, since local anesthesia does not last long.

Patient complaints about temporary numbness after novocaine blockade, which passes within the first 18-20 hours, as well as internal heat at the injection site and a feeling of distension are associated with the specific effect 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. Firstly, side effects of novocaine may appear - in the form of general weakness, dizziness, decreased blood pressure or skin rashes of an allergic nature.

Secondly, the procedure may have negative consequences:

• failure to comply with the technique of its implementation, 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 asepsis;
• increased dose of the drug.

In the latter case, the patient first experiences increased anxiety and nervous excitement (with the appearance of convulsions, increased respiratory rate), which develops into CNS depression, decreased heart rate and respiration, and loss of consciousness. And the entry of a significant amount of novocaine into the systemic bloodstream can lead to cardiac arrest.

The high efficiency of correctly performed novocaine blockade has been proven by decades of use in clinical practice, and pain relief has a positive effect not only on the condition of patients, but also on the results of treatment with other drugs and methods.

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Care after the procedure

No special care is required after the procedure: the doctor monitors the patient's condition after the manipulation (from half an hour to two hours). If the patient is ambulatory and does not undergo hospital treatment, he returns home an hour or an hour and a half after the blockade and after a day of rest and some dietary restrictions (excluding heavy food) can resume his usual activities and eat as usual. However, drinking alcohol after a novocaine blockade is contraindicated for at least a week.

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