Presacral block

The medical anesthetic procedure used in proctology and surgery is presacral block. Consider the indications for its implementation, technique, complications.

Any part of the nervous system under the influence of certain factors can become a permanent or temporary source of neurodystrophic disorders in the body. Irritation causes parabiosis of the nerves in the lesion, which makes it difficult to transmit impulses from the receptors to the nerves and vice versa.

Benefits of therapeutic blockades:

• Reusable for therapeutic purposes.
• Minimal risk of complications (the drug is administered locally, therefore, it enters the general bloodstream in a minimal amount).
• Effective and quick relief of pain (local injection of anesthetic reduces or completely eliminates discomfort).

Presacral or pararectal blockade acts as a method of local anesthesia, that is, anesthetizes the lesion. Thanks to this, the procedure is used in many operations and manipulations on the anus, injuries of the sacrum, coccyx and pelvis.

Indications for the procedure

The main indication for the use of presacral blockade is the relief of severe pain. The purpose of the procedure is to relieve acute pain in the coccyx and sacrum.

The technique is based on the temporary blocking of nerve signals in a specific area. The anesthetic blocks the hypogastric and sacrococcygeal nerve plexuses. The procedure quickly eliminates physical and psycho-emotional problems. [1]

Presacral block is indicated for the following conditions:

• Acute hemorrhoids.
• Anal fissures.
• Sacrum injuries.
• Prostatitis.
• Priapism.
• Cystalgia.
• Coccygodynia.
• Premature ejaculation.
• Injuries to the limbs, pelvis, chest.
• Renal and hepatic colic.
• Obstetric and gynecological pathologies.

The analgesic effect of the blockade occurs instantly. The anesthetic permeates the mucous membrane, blocks the surrounding nerve endings and the focus of inflammation. The procedure also reduces the permeability of the vascular walls, inhibits the growth of pathogenic microflora, reduces sensitivity to allergens and relieves spasms of smooth muscles. [2]

Preparation

Local anesthetic agents affect the functional state of the nerve, disrupting its excitability and conductivity. A reversible process of so-called parabiotic inhibition develops in the nerve, which prevents the passage of impulses.

As before any medical procedure, the patient undergoes special training before the presacral blockade. It consists in a cleansing enema on the day of manipulation. If the blockade is performed for severe pain, then preparation is not required. Also, the doctor asks the patient about the presence of contraindications to the use of medicinal anesthetics.

Technique of the presacral blockade

Presacral block is the injection of anesthetic into the area in front of the first and second sacral foramen on one or both sides.

The technique of performing a presacral blockade includes:

• Before the procedure, the patient's allergic history should be checked.
• Strict adherence to melted asepsis.
• Before the puncture, intradermal anesthesia is performed in the area where the needle is inserted.
• For blockade use long needles 10-20 cm, syringes 10-20 ml.
• The needle is inserted slowly to avoid damage to the nerves and blood vessels.
• After the procedure, the patient is recommended to bed rest for 1-2 hours.

The procedure is carried out in a doctor's office in a proctological / gynecological chair or on a couch (the patient is laid on her side, pulling her knees to her stomach). [3]

The blockade is performed with a long needle, injecting anesthesia 2 cm to the side and ventrally from the apex of the coccyx, in the direction of the first and second sacral holes. The needle travel is controlled with a finger through the patient's rectum. Before the first and second sacrum, about 50 ml of a 0.5% solution of novocaine is administered, the maximum dose is 150 ml of a 0.5% solution.

Presacral novocaine blockade

Novocaine is a local anesthetic drug. The drug blocks sensitive nerve fibers and endings, providing an anesthetic effect. The drug has a wide range of therapeutic uses. Its introduction and absorption into the bloodstream has the following effect on the body:

• Reduces the excitability of peripheral cholinergic systems.
• Reduces the formation of acetylcholine.
• Reduces spasms of smooth muscles.
• Reduces the excitability of the heart muscle and motor areas of the cerebral cortex.
• Toxic doses cause excitement and paralysis of the central nervous system.

Presacral novocaine blockade is prescribed to reduce or completely relieve pain. The procedure is performed for various neurological, surgical and traumatological pathologies.

Indications for blockade:

• Limb injuries.
• Injury to the pelvis and chest.
• Frostbite.
• Renal and hepatic colic.
• Acute hemorrhoids.
• Sacrum injuries.
• Obstetric and gynecological diseases and more.

Once in the body, novocaine is rapidly hydrolyzed, forming pharmacological active substances: diethylaminoethanol and para-aminobenzoic acid. The drug has a fast and at the same time short-term action. To reduce its absorption and prolong the action, when carrying out local anesthesia, 0.1% adrenaline hydrochloride solution is added to the solution (1 drop per 2-10 ml of novocaine). [4]

If the drug is used for local anesthesia, then its amount and concentration directly depend on the nature of the surgery, the route of administration, and the patient's body weight. The procedure is not carried out for allergic reactions to novocaine, peritonitis, systemic infections, terminal condition, during pregnancy and for patients under 18 years of age.

Novocaine blockade has a complex effect on both the central nervous system and the peripheral nervous system. Thanks to this, the cerebral cortex is freed from strong pain impulses. Strong irritation goes away, the reflex-trophic function of the nervous system is restored. As a result of the blockade, tissue trophism improves and the disease acquires a favorable course. [5]

Contraindications to the procedure

Pararectal blockade is placed in the area adjacent / adjacent to the focus of pain, in some cases in the focus itself. Despite the effective analgesic effect, the procedure has a number of contraindications for conducting:

• Inflammatory processes on the skin in the area of administration of the anesthetic.
• Individual intolerance to the drug / local anesthetics.
• Collapse, terminal states.
• Pathologies associated with the destruction of the sheath of nerve endings (myelin).
• Abscess formation of tissues.
• Persistent hypotension, arrhythmias.
• The presence of inoperable neoplasms.
• Bleeding.
• Peritonitis, septicemia.

The procedure is carried out in an outpatient clinic, that is, with complete sterility. Before carrying out the blockade, the doctor clarifies whether the patient has the above contraindications and assesses the risk of complications. [6]

Complications after the procedure

Pararectal treatment blockade is a low-traumatic procedure with a minimal risk of complications. In most cases, problems arise when the rules of asepsis and antiseptics, the technique of carrying out and the individual reactions of the patient's body are violated.

The following complications are distinguished:

• Subcutaneous paraproctitis at injection sites.
• Overdose of a local antiseptic and its toxic effects on the body.
• Introduction of the solution into a blood vessel (risk of toxic effects. To prevent it, an aspiration test is indicated).
• Various anaphylactic reactions.
• Deep tissue infection (infiltrates, abscesses, phlegmon).
• Bleeding.

The risk of complications increases significantly with the introduction of combined solutions. To prevent anaphylactic, toxic and other reactions, an allergic history should be taken and the possibility of interaction of various drugs should be taken into account.

Consequences after the procedure

According to medical statistics, the consequences after a presacral blockade are extremely rare, but it is necessary to remember about the risk of their occurrence.

Post-procedural consequences are divided into two groups:

1. Local:

• Severe pain.
• Puffiness.
• Bruising.
• Tissue necrosis.
• Nonspecific inflammatory processes.

2. General:

• Allergic reactions (decreased blood pressure, edema, itching, rash, respiratory failure).
• Toxic (headaches and dizziness, tachycardia, coma).
• Traumatic (impaired sensitivity, hematomas).
• Inflammatory reactions.

Therapeutic blockade is a highly effective method of pain relief, but only the attending physician can prescribe and carry out it. The doctor evaluating the patient's condition, the possible effectiveness of the blockade, introduces the technique of its implementation and the features after the procedural state. [7]

Care after the procedure

Pararectal blockade is performed on an outpatient basis using anesthetics. In case of normal health, the patient can leave the hospital and return to his usual lifestyle immediately after the procedure.

It is extremely rare for patients to complain of general weakness, dizziness and other painful symptoms. In this case, the patient is left in the hospital until the general well-being improves (this does not take more than an hour).

If the presacral block was performed for the purpose of surgical intervention, then the patient may require longer observation and supportive therapy. In this case, the patient is informed that local anesthesia lasts for 1-1.5 hours, after which pain may occur, which disappears over the next several hours.

Reviews

Presacral block has been widely reviewed as an effective local pain reliever. In this case, the procedure has a minimal effect on the body, in contrast to general anesthesia. That is, recovery from the blockade does not require effort, and the risk of complications is minimal.