RU2812576C1 - Method of performing paravertebral spine block for vertebrogenic diseases of nervous system - Google Patents

Abstract

FIELD: medicine; vertebrology.

SUBSTANCE: invention can be used for paravertebral blockade of the spine for vertebrogenic diseases of the nervous system. For paravertebral blockade of the spine, the patient is placed in a position that ensures relaxation of the spinal muscles. The paravertebral point of the spine is palpated in the innervation zone, while to block the cervical spine, palpation is carried out in the middle and lower parts of the cervical spine. Aflutop is injected between the spinous processes of the vertebra in the area of innervation of the problem area and the vertebra located below, and on the sides of the apex of the transverse process of the vertebra in the area of innervation, and for paravertebral blockade of the thoracic and/or lumbar spine before injecting Aflutop between the apices of the spinous processes in the area of innervation of the problem area and adjacent vertebrae, and at the exit points of the nerve endings of the spinal canal roots, dexamethasone and lidocaine are injected together, after which Alflutop is injected into the same points. When blocking the cervical spine and relaxing the cervical-collar area of the spine, the patient is placed in a sitting position facing the couch, the patient’s elbows and forearms are rested on a horizontal surface, and the head is tilted forward. When blocking the thoracic and/or lumbar spine and relaxing the muscles of the mentioned sections of the thoracic and lumbar spine, the patient is placed in a prone position on his stomach, arms at his sides, head turned to the side. To provide paravertebral blockade of the cervical spine, Alflutop is administered in a volume of 1 ml. The blockade of the cervical spine is performed in a course of 5 times with a frequency of once every two days, 3–4 times a week. Dexamethasone and lidocaine are administered in a volume of 4 mg and 2 ml, respectively, per zone. Aflutop for paravertebral blockade of the thoracic and/or lumbar spine is administered in a total volume of 1 ml per zone in a course of 5 times every other day up to 3 times a week, and the entire course is carried out every six months.

EFFECT: method ensures increased effectiveness of treatment of vertebrogenic diseases of the nervous system due to the placement of the patient in a position that ensures relaxation of the spinal muscles and the characteristics of medicinal products administration.

7 cl, 5 ex

Description

The present invention relates to medicine, in particular, to methods for performing paravertebral spinal blockade for vertebrogenic diseases of the nervous system [A61P 19/00].

The use of the drug Alflutop (A) for osteochondrosis of the lumbar spine (OLS) with chronic back pain syndrome is known from the prior art [CLINICAL EFFICACY OF ALFLUTOP IN SPINAL OSTEOCHONDROSIS (12-MONTH STUDY) Hodyrev V.N., Golikova L.G. Clinical effectiveness of alflutop for spinal osteochondrosis (12-month study). Scientific and practical rheumatology. 2005;43(2):33-36. https://doi.org/10.14412/1995-4484-2005-1522]. During the above-mentioned study, 32 people. with ACOP and lumbodynia: 14 of them (Group I, main) for one year received 2 courses A of 1.0 ml IM daily, 30.0 ml per course + non-steroidal anti-inflammatory drugs (NSAIDs) if necessary; 18 people (II group, control) only NSAIDs. Clinical examination of patients was carried out at the beginning of the study, before and after each course A and after 3 months. after the last course. Persons from the control group were examined at the same time. According to the results of the study, back pain at rest and when bending the body forward in patients of group I significantly (p < 0.05) decreased after each course A. Complete disappearance of pain after the 1st course of treatment A was noted by 7.1%, and after 2 - 35.7% of patients in the main group, which was not observed among those in the control group. A significant stepwise (p < 0.001) decrease in the value of the Thomayer test was also established in group I of patients: through Snake, after completion of treatment A, it decreased by 3.6 times compared to the original one. During the treatment period, these patients showed a 2-2.5-fold increase in the volume of static and dynamic load on the spine (according to the Wadel chronic disability index). 42.9% of patients in the main group and only 5.6% of patients in the control group stopped taking NSAIDs after finishing treatment A. Tolerability of A was good, the drug was combined with all other medications that patients used in connection with concomitant pathology.

The disadvantage of the analogue is the low effectiveness of treatment, side effects with intramuscular administration of non-steroidal anti-inflammatory drugs, as well as the likelihood of damage when performing injections.

The closest in technical essence is LOCAL INJECTION THERAPY FOR DEGENERATIVE DISEASES OF THE JOINTS AND SPINE [LOCAL INJECTION THERAPY FOR DEGENERATIVE DISEASES OF THE JOINTS AND SPINE: FOCUS ON ALFLUTOP. K.V. Raimuev, N.F. Fomin, A.M. Lila, I.B. Belyaeva. Northwestern State Medical University named after. I.I. Mechnikov, Military Medical Academy named after. CM. Kirov. "EFFECTIVE PHARMACOTHERAPY. Rheumatology. Traumatology. Orthopedics" No. 1 (12)], which involves administering the drug Alflutop intramuscularly, intraarticularly, paravertebrally, periarticularly, to pain points for fibromyalgia. Depending on the clinical situation, administration regimens may be as follows:

in case of involvement of multiple joints - deep intramuscular injection, 1 ml daily for 20 days;

in case of involvement of large joints in the process - 2 ml intra-articularly into each affected joint once every three days (six injections), followed by intramuscular injection of 1 ml daily for 20 days;

in case of damage to the spine - paravertebral 0.25 ml at four points (1 ml in total) at the level of two adjacent segments twice a week (five injections), followed by intramuscular injection of 1 ml daily for 20 days. It is advisable to repeat the course of treatment after three to six months;

for polyosteoarthrosis and osteochondrosis - deeply intramuscularly, 1 ml per day (20 injections in total);

a combination of intra-articular and intramuscular administration is possible. It is advisable to repeat the course of treatment after six months.

The main technical problem of the prototype is the low efficiency of treatment due to the long interval between paravertebral injection procedures. In addition, the known therapy does not disclose the use of the drug Alflutop for vertebrogenic diseases of the nervous system.

The objective of the invention is to eliminate the shortcomings of the prototype.

The technical result of the invention is to increase the effectiveness of treatment of vertebrogenic diseases of the nervous system.

The specified technical result is achieved due to the fact that the method of performing paravertebral blockade of the spine for vertebrogenic diseases of the nervous system, characterized by palpation of the paravertebral point in the innervation zone of the problem area, marking the apex of the spinous process of the found and adjacent vertebrae, paravertebral administration of the drug Alflutop to the marked places, differs in that for paravertebral blockade of the spine, the patient is placed in a position that ensures relaxation of the spinal muscles, the paravertebral point of the spine is palpated in the innervation zone, while for blockade of the cervical spine, palpation is carried out in the middle and lower parts of the cervical spine, and the drug Alflutop is administered between spinous processes of the vertebra in the zone of innervation of the problem zone and the vertebra located below, and on the sides of the apex of the transverse process of the vertebra in the zone of innervation, and for paravertebral blockade of the thoracic and/or lumbar spine, before administering the drug Alflutop, a course of blockade with dexamethasone and lidocaine is administered, which is administered between the tips of the spinous processes in the area of innervation of the problem area and adjacent vertebrae and at the exit points of the nerve endings of the spinal canal roots, after which a course of blockade with the drug Alflutop is administered, which is injected into the same points.

In particular, when blocking the cervical spine and relaxing the cervical-collar area of the spine, the patient is placed in a sitting position facing the couch, the patient’s elbows and forearms are supported on a horizontal surface, and the head is tilted forward.

In particular, when blocking the thoracic and/or lumbar spine and relaxing the muscles of the mentioned sections of the thoracic and lumbar spine, the patient is placed in a prone position on his stomach, arms at his sides, head turned to the side.

In particular, for paravertebral blockade of the cervical spine, the drug Alflutop is administered in a volume of 1 ml.

In particular, the blockade of the cervical spine is carried out in a course of 5 times with a frequency of once every two days.

In particular, dexamethasone and lidocaine are administered in a volume of 4 mg and 2 ml, respectively, per zone.

In particular, the drug Alflutop for paravertebral blockade of the thoracic and/or lumbar spine is administered in a total volume of 1 ml per zone in a course of 5 times every other day, and the entire course is carried out every six months.

Implementation of the invention.

The essence of the invention lies in paravertebral blockade of the cervical and/or thoracic and/or lumbar spine.

To carry out paravertebral blockade of the cervical spine, the patient is placed in a sitting position facing the couch, the patient’s elbows and forearms rest on a horizontal surface, the head is tilted forward to ensure relaxation of the cervical-collar area.

By palpation, the cervical vertebra in the innervation zone is determined. When performing paravertebral blockade of the cervical spine, palpation with further administration of the drug Alflutop is carried out in the middle and lower parts of the cervical spine at the level of the cervical vertebrae C4 - C7, which minimizes the occurrence of side effects when performing injections and introducing the drug into the cervical spine.

Marking is carried out on the apex of the spinous process and the apexes of the transverse process of at least one cervical vertebra C4-C7, at the level of which the procedure will be performed, as well as the apex of the spinous process of the vertebra lower in relation to the mentioned vertebra.

After this, Alflutop is sequentially administered from above and below between the mentioned spinous processes and on the sides of the apices of the transverse process of the cervical vertebra in the innervation zone.

In this case, the drug Alflutop is administered at an angle of 45-60 degrees to the skin strictly parallel to the process and perpendicular to the surface of the skin to a penetration depth of the insulin syringe of approximately 1 cm. To administer the drug, a 1 ml insulin syringe with a thin needle is used, which allows to minimize the occurrence of hematomas and injuries and damage to nerve endings. In non-limiting embodiments of the invention, an insulin syringe with a needle diameter of 0.30 or 0.25 or 0.23 mm is used to administer the drug.

Alflutop is administered in a total of four injections in a volume of 1 ml.

The drug Alflutop has chondroprotective, anti-inflammatory, and trophic effects. The active component is a bioactive concentrate from small sea fish. The drug is characterized by a rapidly developing clinical effect, a long aftereffect period (four to six months), and a high safety profile. Can be recommended for wide use in rheumatological, neurological, therapeutic, traumatological and orthopedic practice.

The proposed blockades are carried out in a course of 5 times, every two days, 3-4 times a week, which allows to minimize damage, ensure exposure time of the drug in the tissues and reduce pain.

After a course of the proposed blockades, there is an improvement in the quality of cartilage tissue and an increase in its elasticity. An important effect after a course of blockades is a decrease in intensity or complete relief of headaches and tinnitus, which are symptoms of compression of the nerve roots or spinal nerves in vertebrogenic diseases of the nervous system

To carry out paravertebral blockade of the thoracic and/or lumbar spine, the patient is placed in a prone position on his stomach, arms at his sides, head turned to the side to straighten the back muscles.

Palpation determines the thoracic and/or lumbar vertebra in the innervation zone. The apex of the spinous process of the found vertebra is marked, as well as the apex of the spinous process and the vertebra next to the one mentioned. Then, at the level between the mentioned apexes at the exit points of the nerve endings of the spinal canal roots at an angle of 45-60 degrees to the skin, dexamethasone is administered together with lidocaine in a volume of 4 mg and 2 ml, respectively, per zone, but not more than 8 mg of dexamethasone and 4 ml of lidocaine in one procedure.

It should be noted that dexamethasone, which belongs to the group of non-steroidal anti-inflammatory drugs, when administered intramuscularly or intra-articularly into the patient’s body, is highly likely to cause side effects characteristic of many drugs in this group - increased susceptibility to thrombosis, increased blood pressure, increased blood glucose levels. blood, the ability to cause stomach ulcers and so on.

At the same time, the introduction of dexamethasone into the patient's body paravertebrally can significantly reduce the risk of the above-mentioned side effects, providing the possibility of using this drug in the treatment of patients who have contraindications to its use for health reasons.

The mentioned blockades with dexamethasone and lidocaine are carried out in an amount of 1 to 10 procedures until the desired effect is achieved, depending on the volume of the problem area or areas and the presence of concomitant diseases. Moreover, unlike blockades with Alflutop, procedures can be performed daily, provided there are no contraindications in the form of increased blood pressure, blood sugar, and others. When a positive effect is achieved, the patient is transferred to the second stage of therapy without waiting for the completion of 10 procedures (as a rule, 5 procedures are enough).

At the second stage of therapy, after blockades with dexamethasone and lidocaine are performed, blockades with Alflutop are performed between the previously marked apices of the spinous process of the vertebra in the innervation zone and the apices of the spinous process following the mentioned vertebra at the exit points of the nerve endings of the roots of the spinal canal at right angles to the skin, the drug Alflutop is injected in volume 1 ml in total per zone. To administer the drug, a 1 ml insulin syringe with a thin needle is also used, which minimizes the occurrence of hematomas, injuries and damage to nerve endings. In non-limiting embodiments of the invention, an insulin syringe with a needle diameter of 0.30 or 0.25 or 0.23 mm is used to administer the drug.

To achieve the maximum therapeutic effect, the proposed blockade of the thoracic and/or lumbar region is performed in 5 procedures per zone, every other day up to 3 times a week. In this case, the mentioned course, consisting of blockades with dexamethasone and lidocaine and blockades with Alflutop, is carried out every six months.

The technical result of the invention - increasing the effectiveness of treatment of vertebrogenic diseases of the nervous system - is achieved by placing the patient in a position that ensures relaxation of the spinal muscles, in particular, when performing paravertebral blockade of the cervical spine in a sitting position facing the couch, the patient's elbows and forearms rest on a horizontal surface , the head is tilted forward, and when performing paravertebral blockade of the thoracic and/or lumbar spine in a prone position on the stomach, hands at the seams, head turned to the side, administration of the drug Alflutop when performing a blockade of the cervical spine at the level of at least one of the cervical vertebrae C4-C7 with the needle positioned at an angle of 45-60 degrees to the skin parallel to the process to the depth of the insulin syringe between the spinous processes of the vertebra in the zone of innervation and the vertebra located below, and on the sides of the apex of the transverse process of the vertebra in the zone of innervation, and for performing paravertebral blockade of the thoracic and/or lumbar spine by jointly administering dexamethasone and lidocaine between the apices of the spinous processes of the vertebrae in the innervation zone and adjacent to it at the exit points of the nerve endings of the spinal canal roots with the syringe needle positioned at an angle of 45-60 degrees to the skin, and administering the drug Alflutop into these same points with the needle positioned at right angles to the skin to the depth of the insulin syringe.

Clinical examples.

Example 1.

Patient S, 82 years old, severe thoracic lordosis with pronounced degenerative changes in the vertebrae, decreased vertebral height and bone growths, experienced severe pain, on a pain scale of 8-9 points, could not care for herself, after a course of blockades with dexamethasone and lidocaine and blockade with Alflutop according to the second embodiment of the invention (5 procedures in a row, then 4 every other day), she was able to return to an independent lifestyle in the village and leave the children.

Example 2.

Patient A, 42 years old, sequestered disc herniation L5S1 8 mm, absolute spinal canal stenosis, was awaiting a quota for surgical treatment, continuing to work as a taxi driver. With the help of a course of blockades with dexamethasone and lidocaine and blockades with Alflutop according to the second embodiment of the invention, and then situationally, approximately once a week, with dexamethasone and lidocaine, it was possible to overcome the pain syndrome. The patient remained able to work during the two months of waiting for surgical treatment, without consequences for health and the development of paresis of the lower extremities.

Example 3.

Patient B, 62 years old, severe cervical lordosis, muscle tension in the cervical collar area, against this background constant headaches, numbness of the arms, limited range of motion in the neck to the sides. After a course of blockades with Alflutop according to the first embodiment of the invention, the numbness completely disappeared, lightness appeared in the body, mood and sleep improved, and pain in the cervical spine was relieved.

Example 4.

Woman K, 38, years old, after discectomy L5S1 in 2018, 2019 and subsequent installation of a metal structure at the level of L5S1 on 03.2021, mild monoparesis of the right lower limb in 4 b, after the last surgical treatment, even with the slightest load, could not walk for a long time and being upright, let alone working while working as a cleaner. Hospital treatment, muscle relaxants and vitamins did not provide the necessary therapeutic effect.

By undergoing courses of blockades with dexamethasone and lidocaine and blockades with Alflutop according to the second embodiment of the invention once every 6 months, it was possible to achieve good remission and continue to work.

Example 5.

Patient C, 48 years old, herniated discs of the vertebrae L4L5 6 mm, L5S19 mm according to MRI, lumbar spine with spinal canal stenosis, with complaints of difficulty walking, moving along with the appearance of sharp, shooting pain in the back, radiating to the left leg up to foot, treatment of the patient is complicated by the presence of severe pathology, insulin-dependent diabetes mellitus, stage 2 obesity, hypertension, while taking ketoral by injection 2 times a day for 3 days and sirdalud 6 mg per day, blood pressure increases to 180/90 mm. rt. Art., increased heart rate up to 87 beats per minute.

When visiting the first blockade procedure, the patient could not bend over to put on shoes; there was pain with any movement. After a course of blockades with dexamethasone and lidocaine and blockades with Alflutop, according to the second embodiment of the invention, a high-quality therapeutic effect was achieved in the form of complete relief of pain and restoration of full range of motion. It is worth noting that when implementing the method, dexamethasone, which is a non-steroidal anti-inflammatory drug, when administered paravertebrally did not lead to an increase in blood pressure, pulse and blood sugar, the patient tolerated the treatment period comfortably. The patient was then able to work and live for eight months without exacerbations of osteochondrosis, performing heavy physical work (builder-finisher).

Claims (7)

1. A method of performing a paravertebral block of the spine for vertebrogenic diseases of the nervous system, characterized by palpation of a paravertebral point in the area of innervation of the problem area, marking the apex of the spinous process of the found and adjacent vertebrae, paravertebral injection of the drug Alflutop into the marked areas, characterized in that for paravertebral block of sections The patient's spine is placed in a position that ensures relaxation of the spinal muscles, the paravertebral point of the spine is palpated in the innervation zone, while to block the cervical spine, palpation is carried out in the middle and lower parts of the cervical spine, and the drug Alflutop is administered between the spinous processes of the vertebra in the innervation zone of the problem zone and vertebra located below and on the sides of the apex of the transverse process of the vertebra in the zone of innervation, and for paravertebral blockade of the thoracic and/or lumbar spine, before administering the drug Alflutop, a course of blockade with dexamethasone and lidocaine is administered, which is administered between the apices of the spinous processes in the zone of innervation of the problem zones and adjacent vertebrae and at the exit points of the nerve endings of the spinal canal roots, after which a course of blockades is carried out with the drug Alflutop, which is injected into the same points. 2. The method according to claim 1, characterized in that when blocking the cervical spine and relaxing the cervical-collar area of the spine, the patient is placed in a sitting position facing the couch, the patient’s elbows and forearms are rested on a horizontal surface, and the head is tilted forward. 3. The method according to claim 1, characterized in that when blocking the thoracic and/or lumbar spine and relaxing the muscles of the mentioned sections of the thoracic and lumbar spine, the patient is placed in a lying position on his stomach, arms at his sides, head turned to the side. 4. The method according to claim 1, characterized in that for paravertebral blockade of the cervical spine, the drug Alflutop is administered in a volume of 1 ml. 5. The method according to claim 1, characterized in that the blockade of the cervical spine is carried out in a course of 5 times with a frequency of once every two days. 6. The method according to claim 1, characterized in that dexamethasone and lidocaine are administered in a volume of 4 mg and 2 ml, respectively, per zone. 7. The method according to claim 1, characterized in that the drug Alflutop for paravertebral blockade of the thoracic and/or lumbar spine is administered in a total volume of 1 ml per zone in a course of 5 times every other day, and the entire course is carried out every six months .