RU2320332C1 - Method for treating edema of the upper limbs - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: into area of brachial plexus due to inter-scalene access one should introduce medicinal mixture that contains 2 ml 2%-lidocaine solution, 0.2 ml 0.05%-proserine solution and 3 ml physiological solution. Injection could be also fulfilled due to axillary access. Before injection it is necessary to carry out electrodiagnostics. Thus, at the first stage one should introduce an electrodiagnostic needle into the axilla at the angle of 45 against skin, towards the caput of brachial bone to affect with the current at power being 1 mA, frequency of 2 Hz till the onset of muscular contractions. After that current power should be decreased up to 0.5 mA. Due to moving the needle mentioned, in case of muscular response it is important to inject medicinal mixture. At the second stage one should introduce the electrodiagnostic needle into area of intersection of imaginary line that connects the end of cricoid cartilage with a spinous process of the 6^th cervical vertebra with inter-scalene sulcus, in direction 40-45 towards sagittal and frontal planes, for the depth of 0.5-1 cm. One should affect with current power of 1 mA till the onset of muscular contractions. After that current power should be decreased up to 0.5 mA. Due to moving the needle, in case of muscular response it is necessary to inject medicinal mixture. The procedure described should be fulfilled thrice, at 48-h-long interval. The innovation improves interstitial drainage due to creating the effect of "muscular pump".

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to surgery. It can be used in the treatment of patients with edema of the upper extremities.

The present method has no analogues; it is distinguished by simplicity of execution, affordability, efficiency and low cost.

The method consists in the combined introduction of a complex mixture of drugs into the brachial plexus region with preliminary electrodiagnostics. The introduction is carried out in two stages. At the first stage, the patient is lying on his back. In the axilla, 1.5 cm below the axillaries artery, a Stimuplex electrodiagnostic needle is inserted at an angle of 45 ° to the skin towards the head of the humerus. On the electric stimulator, the pulse frequency is set at 2 Hz, and the current strength is 1 mA. With the advancement of the needle, muscle contractions of the innervated region are noted, the current strength on the electric stimulator is reduced to 0.5 mA, and the needle is further advanced. If there is a response of the stimulator to the test dose of the pulse, a drug mixture is introduced. The composition of the drug mixture includes 2 ml of a 2% solution of lidocaine, 0.2 ml of a 0.05% solution of proserin, 3 ml of physiological saline. During the second stage, the patient is in a sitting position. At the intersection of the imaginary line connecting the edge of the cricoid cartilage with the spinous process of the sixth cervical vertebra, with the interstitial groove, a Stimuplex needle is inserted in the direction of 40-45 ° to the sagittal and frontal planes, the needle is drawn to a depth of 0.5-1 cm, depending on the severity subcutaneous tissue until muscle contractions occur during electrical stimulation with a current strength of 1 mA, after which the current strength is reduced to 0.5 mA, the needle is further advanced. If there is a response of the stimulator to the test dose of the pulse, a drug mixture is introduced in the composition of 2 ml of a 2% solution of lidocaine, 0.2 ml of a 0.05% solution of proserin, 3 ml of physiological solution. Multiplicity of performance of manipulations: three times with an interval of 48 hours.

The technical result is to improve the work of the muscular-venous pump, which resulted in a decrease in edema of the upper extremities. Contraindications for injections are: intolerance to any drug that is part of medicinal mixtures, local purulent processes in the field of this manipulation.

In order to evaluate the effectiveness of the proposed method of treatment, a comparative analysis of case histories of 35 patients with edema of the upper extremities who underwent conventional treatment and 28 patients with edema of the upper extremities who underwent a combination of generally accepted treatment and combined introduction of a complex mixture of drugs into the shoulder region plexus. Assessment of the effectiveness of the therapy was carried out by means of a comparative analysis of impedance, thermal imaging, and anthropometric studies. As a result, it was proved that the application of the proposed method in the treatment of patients with edema of the upper extremities leads to a decrease in the active component of the specific resistance of soft tissues at all levels of the study, to an increase in skin temperature and allows to reduce the circumference of the upper extremities. Comparative data are given in the tables. In the control group, patients received conventional treatment.

Table 1 Data from an anthropometric study of the upper limbs conducted in patients with edema of the upper extremities who received conventional treatment and a combination of conventional treatment and the combined introduction of a complex mixture of drugs into the brachial plexus region. cm, M ± m. Study levels Conventional treatment (n = 35) Conventional treatment + proposed treatment method (n = 28) Before treatment After treatment Before treatment After treatment Brush 21.5 ± 0.9 21 ± 0.8 21 ± 0.8 19 ± 0.6 * Wrist joint 20.5 ± 0.7 20 ± 0.7 20.5 ± 0.8 18.5 ± 0.6 * Lower third of the forearm 22 ± 1 21 ± 0.9 22.5 ± 0.9 20.5 ± 0.7 * Middle third of the forearm 31.5 ± 1.3 30.5 ± 1.2 29.5 ± 1.1 26.5 ± 1 * Upper third of the forearm 37 ± 1,5 35.5 ± 1.3 39 ± 1.7 34 ± 1.3 * Lower third of the shoulder 38.5 ± 1.7 37 ± 1,6 39.5 ± 2 35.5 ± 1.6 * Middle third of the shoulder 39 ± 1.7 37.5 ± 1.7 40.5 ± 2.1 37 ± 1.8 * Upper third of the shoulder 39 ± 1.8 38 ± 1.8 40 ± 2.2 37 ± 1.9 * Note: * - differences in indicators before and after treatment are significant, p <0.05

table 2 Data from an impedance study of the upper limbs conducted in patients with edema of the upper extremities who received conventional treatment and a combination of conventional treatment and the combined introduction of a complex mixture of drugs into the brachial plexus region. Ohm, M ± m Study levels Conventional treatment (n = 35) Conventional treatment + proposed treatment method (n = 28) Before treatment After treatment Before treatment After treatment Brush 42.5 ± 1.7 43 ± 1.8 42 ± 1.7 46.5 ± 1.7 * Wrist joint 40.5 ± 1.6 41.5 ± 1.7 42 ± 1.7 45 ± 1.6 * Middle third of the forearm 47.5 ± 1.8 49 ± 1.9 46.5 ± 1.8 52.5 ± 2.3 * Upper third of the forearm 49 ± 1.8 50.5 ± 2 48 ± 1.9 56.5 ± 2.6 * Lower third of the shoulder 51.5 ± 1.9 53 ± 2,3 52 ± 2 60 ± 2.9 * Upper third of the shoulder 58 ± 2,5 59 ± 2.9 57.5 ± 2.4 66 ± 3.4 * Note: * - differences in indicators before and after treatment are significant, p <0.05

Table 3 Data from a thermal imaging study of the upper limbs conducted in patients with edema of the upper extremities who received conventional treatment and a combination of conventional treatment and the combined introduction of a complex mixture of drugs into the brachial plexus region, ° С, M ± m Study levels Conventional treatment (n = 35) Conventional treatment + proposed treatment method (n = 28) Before treatment After treatment Before treatment After treatment Brush 28.6 ± 1.3 29.2 ± 1.4 28.2 ± 1.3 31.4 ± 1.4 * Forearm 29.3 ± 1.5 29.8 ± 1.5 28.8 ± 1.4 32.9 ± 1.5 * Shoulder 29.7 ± 1.5 30.6 ± 1.4 29.5 ± 1.5 33.6 ± 1.6 * Note: * - differences in indicators before and after treatment are significant, p <0.05

Clinical example.

Patient J., 48 years old. Diagnosis: Postmastectomy lymphedema of the left upper limb, II tbsp. In 2003, she underwent radical mastectomy on the left, before and after surgical treatment she underwent chemotherapy and radiation therapy, 6 months after the operation she noted the appearance of swelling of the left upper limb, and the swelling intensified over time. On admission, the circumference of the upper limbs was respectively right / left in centimeters: hand 18/22, wrist joint 17.5 / 21.5, lower third of the forearm 18.5 / 24, middle third of the forearm 22.5 / 32.5, upper third forearm 24.5 / 40, the lower third of the shoulder 27 / 41.5, the middle third of the shoulder 30.5 / 42, the upper third of the shoulder 33/42. No trophic disorders were detected. Examination - impedancemetry, thermal imaging of the upper limbs. Treatment - standard conservative therapy, lymph press, elastic bandaging, elevation of the limb. The patient underwent three sessions of combined administration of a complex mixture of drugs into the brachial plexus region, the composition of the drug mixture was 2 ml of a 2% lidocaine solution, 0.2 ml of a 0.05% proserin solution, 3 ml of physiological saline, with an interval of 48 hours. After completion of therapy, there is a decrease in swelling of the left upper limbs: hand 18/19, wrist joint 17 / 18.5, lower third of the forearm 18.5 / 21.5, middle third of the forearm 22/28, upper third of the forearm 23.5 / 35, 5, the lower third of the shoulder 27/36, the middle third of the shoulder 30/38, the upper third of the shoulder 32.5 / 38.5. An increase in the active component of the specific resistance of soft tissues at all levels of the study was found: at the level of the hand before treatment of 41.5 Ohms, after treatment of 46 Ohms, at the level of the wrist joint before treatment of 41.5 Ohms, after treatment of 49.5 Ohms, at the middle third of the forearm before treatment 47 Ohms, after treatment 52.5 Ohms, at the level of the upper third of the forearm before treatment 48.5 Ohms, after treatment 55 Ohms, at the level of the lower third of the shoulder before treatment 52.5 Ohms, after treatment 60.5 Ohms , at the level of the upper third of the shoulder before treatment of 57 Ohms, after treatment of 65.5 Ohms. The following dynamics of skin temperature was noted: at the level of the hand before treatment 28.4 ° C, after treatment 31.8 ° C, at the level of the forearm before treatment 29.1 ° C, after treatment 33.1 ° C, at the shoulder level before treatment 29.4 ° C, after treatment 33.5 ° C.

The combined introduction of a complex mixture of drugs into the brachial plexus region causes elementary skeletal muscle contractions, which create the effect of a “muscle pump”, which leads to improved interstitial drainage. Using this method allows you to effectively influence the pathological process with edema of the upper extremities, to achieve a more pronounced decrease in edema compared with conventional treatment, which is confirmed by the data of anthropometry, impedance measurement and thermal imaging studies.

Claims (1)

A method for the treatment of edema of the upper extremities, comprising introducing a drug mixture containing a lidocaine solution into the region of the brachial plexus with interstitial access, characterized in that a drug mixture containing 2 ml of a 2% solution of lidocaine, 0.2 ml of 0.05% Proserine solution and 3 ml of physiological saline, administration is also carried out by axillary access, while electrodiagnostics is performed before administration, for which, at the first stage, an electrodiagnostic needle is introduced into the armpit 1.5 cm below the axillaries artery at an angle of 45 ° to the skin, towards the head of the humerus, they are exposed to a current of 1 mA, a frequency of 2 Hz until muscle contractions occur, after which the current is reduced to 0.5 mA and, advancing the needle, if there is a muscular response, it is introduced drug mixture, and at the second stage, an electrodiagnostic needle is inserted into the intersection of the imaginary line connecting the edge of the cricoid cartilage with the spinous process of the sixth cervical vertebra with the interstitial groove, in the direction of 40-45 ° to the sagittal and frontal planes, to a depth of 0.5-1 cm and in zdeystvuyut current strength of 1 mA until the occurrence of muscular contractions, then the current strength is reduced to 0.5 mA, and advancing the needle, in the presence of muscle response administered drug mixture, the procedure is performed three times, with an interval of 48 hours.