RU2536283C1 - Method for novocaine block - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: patient is laid on his/her side opposite a block region. A guide mark is a vertical line in a projection of Petit's triangle from the twelfth rib to a wing of ilium. A needle is pricked into the skin on the vertical line at 1.5-2.5cm above the wing of ilium. 0.25% Novocaine is administered in layers into the skin and subcutaneous fat. The needle is advanced into the lumbar region from back to front in the medial direction along the lateral edge of broadest muscle of back at 6-8cm. Novocaine 120ml is administered into the lower order of the lumboiliac fossa formed in this region.

EFFECT: effective and safe pain management in the given category of patients by providing the required Novocaine concentration in the retroperitoneal space.

1 dwg, 1 ex

Description

The invention relates to medicine, in particular to urology, can be used in the treatment of renal colic, orthoepididymitis.

Known perirenal procaine blockade in case of renal colic, in which the patient lies on his side, under the lower back is a roller, the leg is bent from below at the knee and hip joints, and from above it is elongated along the trunk. They find the musculo-rib angle (the intersection of the XII rib and the long muscles of the back), 1-2 cm from the top along the bisector, and inject the needles. Direction of the needle: perpendicular to the surface of the skin (the needle is directed at the navel of the patient). A sign of finding the needle in the perinephric tissue: when removing the syringe from the needle, the solution does not drip from the pavilion, but is drawn inward when breathing. After getting into the perinephric tissue, 60-100 ml of a 0.25% solution of novocaine is administered. One-sided perinephral blockade (renal colic) is possible, but more often bilateral is used (the described manipulations are performed sequentially from two sides), (see Ostroverkhov G.E., Bomash Yu.M., Lubotsky D.N. Operative surgery and topographic anatomy. - 1996).

The reasons that impede the achievement of the following technical result when using the known method include the fact that such formidable complications as a needle getting into the kidney, damage to the blood vessels of the kidney, damage to the ascending or descending colon, and nephrosclerosis often occur.

The objective of the invention is to provide a method of novocaine blockade, which provides a technical result that allows you to create the necessary concentration of novocaine in the retroperitoneal space, and also reduces the risk of iatrogenic complications.

The technical result is achieved in that the method of novocaine blockade involves determining the point of skin puncture with a needle and introducing a 0.25% solution of novocaine through it.

The peculiarity is that the patient is placed in the supine position on the side opposite to the blockade, as a guide, draw a vertical line in the projection of the Petitov triangle from the end of the twelfth rib to the iliac wing, then retreat by 1.5-2 on the vertical line, 5 cm above the iliac wing and inject the needle into the skin, inject a solution of novocaine into the skin and subcutaneous fat in layers, advance the needle into the lumbar region from front to back in the medial direction along the lateral edge, muscle of the back to a length of 6-8 cm in the lower edge of the lumbosacral fossa formed in this area, into which 120 ml of novocaine is directly injected.

The invention is illustrated in the drawing, where

1 is a vertical landmark line drawn from the end of the twelfth rib to the ilium wing,

2 - the ilium wing,

3 - place injection needle,

4 - lateral edge of the latissimus dorsi,

5 - the posterior edge of the external oblique muscle of the abdomen.

The method is as follows.

The patient is placed in a supine position on the side opposite to the blockade. In the projection of the Petitov triangle, as a guideline, draw a vertical line 1 from the end of the twelfth rib to the wing 2 of the ilium. On this vertical line 1, retreating 1.5-2.5 cm above the wing of the ilium, 3 needles are injected into the skin and a 0.25% solution of novocaine is injected into the skin and subcutaneous fat in layers. The needle is advanced into the lumbar region from front to back in the medial direction to a length of 6-8 cm and gets to the lateral edge of the 4 latissimus dorsi, which forms the lower edge of the lumbar iliac fossa in this area. This section of the retroperitoneal space is the boundary between the lumbar region and the pelvic cavity. A solution of novocaine in the amount of 120 ml is injected directly into this space.

The method of novocaine blockade allows you to create the necessary concentration of novocaine in the retroperitoneal space to relieve pain, and also reduces the risk of iatrogenic complications.

Clinical example.

Patient M., 47 years old, on June 9, 2012 turned to the urology department of the State Health Institution “Ulyanovsk Regional Clinical Center for Specialized Medical Care in Ulyanovsk” with complaints of pain in the right lumbar region with radiation to the supral region, frequent urination. A history of urolithiasis for 5 years. A standard survey volume has been completed. According to an ultrasonographic study, pyelokalikoectasia was found on the right, in the distal ureter, a calculus with a diameter of 4 mm. Diagnosis: Urolithiasis. Stone of the lower third of the right ureter. Right-sided renal colic.

06.09.2012, the patient performed novocaine blockade. The patient is lying on his left side. S. Novocaini was introduced from the right side in the projection of the Petitov triangle. A landmark line was drawn from the end of the 12th rib vertically to the iliac wing, along which, retreating 2 cm above the iliac wing, pierced the skin and introduced S. Novocaini in layers into the skin, subcutaneous fat, advancing the needle into the lumbar region for a length of 7 cm and getting to the lateral edge of m.iliopsoas, which forms in this area the lower edge of the lumbar iliac fossa. S. Novocaini 0.25% 120 ml was injected directly into this space. The pain is completely stopped. Given the small size of the calculus and the possibility of independent lithokinesis, the patient was given recommendations, she was allowed to go home for outpatient treatment.

On the 7th day of conservative therapy, an independent discharge of calculus occurred. The patient was examined after 1 month, 6 months - satisfactory condition, no complaints.

Thus, the proposed method allows you to create the necessary concentration of novocaine in the retroperitoneal space to relieve pain, and also reduces the risk of iatrogenic complications.

Claims (1)

The method of novocaine blockade in case of renal colic or orchoepididymitis, including determining the point of skin puncture with a needle and introducing a 0.25% solution of novocaine through it, characterized in that the patient is placed in the supine position on the side opposite to the blockade, as a guide a vertical line in the projection of the Petitov triangle from the twelfth rib to the iliac wing, then they retreat 1.5-2.5 cm above the iliac wing on the vertical line and inject the needle into the skin, inject the solution layer by layer p novocaine into the skin and subcutaneous fat, advance the needle into the lumbar region from front to back in the medial direction along the lateral edge of the latissimus dorsi muscle to a length of 6-8 cm into the lower edge of the lumbar iliac fossa formed in this area, into which the solution is directly injected novocaine in an amount of 120 ml.

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