SU1256753A1 - Method of treatment of postamputational pains - Google Patents

Description

This invention relates to medicine, namely to traumatology and orthopedics.

The purpose of the invention is to reduce the duration of treatment;

The method is carried out as follows.

In the area of the projection of the nerve trunk, a needle is inserted in accordance with external landmarks. For searching and identifying the nerve trunk, a search device is used, which is a low-frequency generator (2.5-3 V; F 2H; R 75 Ohm). The needle is in contact with the nerve and is judged to reduce the corresponding band. as a result of stimulation of motor fibers that go as part of the nerve trunk. After reaching the needle contact with the nerve, 70-100 ml of a 0.25% solution of novocaine or trimecain are injected. Any local anesthetic can be used at a concentration that causes a differentiated block of thin (non-myelinated) nerve fibers. The conductivity of the thick (motor) fibers is again checked. They, like steel thick myelinated fibers, should not be blocked by the anesthetic, which means that the response to stimulation must be maintained. A catheter is then inserted into the needle lumen. As soon as the catheter advances through the needle and ceases to feel the bottom, the needle is gently removed, holding the catheter in place. The free end of the catheter is fixed on the skin. At a block level or more distal, electrodes are placed for percutaneous stimulation. The electrodes are placed around the circumference of the truncated limb or along its nerve trunk. The electrostimulation is carried out with monophasic and rectangular current pulses with a duration of 0.1-0.2 ms, with a frequency of 60-70 Hz. The magnitude of the amplitude value of the stimuli is selected individually depending on the patient's sensations within 30-45 V. The nerve trunk electrostimulation is performed 2-3 times a day for 1.5-2 hours. The anesthetic through the catheter is administered 1 time per day. Treatment continues for 7-10 days.

Example 1. Patient Shu-ev, 64 years old, entered the orthopedic department of the Moscow hospital of invalids of the Patriotic War of 20.09.83. Discharged on 10/26/83. Diagnosis: phantom pain syndrome stump of the left shoulder.

Complaints on admission to pain in the I, II fingers, in the area of the I interdigital gap, palm missing hand.

History data: amputation in 1943 after a gunshot wound to the shoulder. Disabled warfare IG group. Pains in the phantom hand appeared shortly after amputation, but the first 20 years did not really disturb the patient. With the intensity of pain increased, the frequency and duration of attacks increased. For the last 10 years, he has received medication therapy and physiotherapy in outpatient, inpatient and sanatorium conditions annually. As a result of the pain syndrome, he underwent one reamputation and neuroma removal surgery. After each course of treatment, the intensity of pain somewhat decreased, the frequency of attacks decreased to 1-2 per day, but this effect was also short-lived.

Objectively: the general condition is satisfactory. On the internal organs without features.

Mental status: negative, weak-minded, tearful.

Neurological status: a well-defined synesthesia symptogatic with the presence of a trigger zone on the inner surface of the shoulder stump.

Locally: a complex of vegetative shifts in the form of a spasm of pilomotors, —powered perspitation and hypothermia of a stump.

Within two weeks he received drug treatment, magnetotherapy and acupuncture. The effect is negligible.

10/6/83 under the control of the search electrostimulator of the torch to the shoulder sple; -, a catheter was brought along the Hempel in a longitudinal way. In the catheter introduced 70 ml of a 0.25% solution of trimekain. After 15 min, the pain disappeared, but after 2 h they appeared again. 70 ml of anesthetic was reintroduced and electrodes of the percutaneous electrostimulator of the ETNS 100-1 were superimposed (one on the inner surface of the left shoulder in the immediate vicinity of the axillary region, the other on the back

vyskosti left forearm). Electrical stimulation was carried out for 2 hours. 10 hours after the end of the stimulation session, pain in the first finger of the missing hand appeared. No anesthetic was administered, the pain was relieved after the electrostimulation session, which lasted 2 hours. Under the morning, the pain was relieved. 70 ml of anesthetic were injected, stimulation started. The pain no longer came. For 6 days, an anesthetic was administered once and electrostimulation was performed. Thus, for the first time in many years achieved. full of remission. The patient was discharged in a satisfactory condition.

Currently (for 5 months) phantom pains are absent.

Example 2. Patient Am Cove, 76 years old.

Diagnosis: amputation cult of the first hip. Chronic pain syndrome with stump pain and phantom.

Complaints on admission to pain in the butt of the stump, on the outer edge of the foot and the front surface of the ankle joint of the missing limb.

 Anamnesis data: amputation in 1944 in connection with a gunshot wound and gas gangrene. Disabled War Group I. The pain in the phantom appeared after 2 weeks after amputation, but after 2.5 years it disappeared. He worked for a long time, did not feel pain, and went on a prosthesis. Ten years ago, the pain returned, there was burning pain in the cult itself. The intensity of pain increased with each passing year, the duration of attacks increased. Completely stopped using the prosthesis. Lechils outpatient, inpatient and sanatorium x. Surgical treatment to eliminate pain by resecting the distal fragment of the truncated sciatic nerve and removing the neuroma did not bring relief.

Objectively: the general condition is satisfactory. In the mental state of the phenomenon of affective-depressive syndrome.

Locally: cutting pain on palpation on the end surface of the stump in front of the femur with pronounced hyperpathy and synalgia. The cult is cold, temperature gradient when compared with symmetrical

section of the left thigh - 4.2 °. Pilomotor spasm and hyperspit stump. On admission prescribed a course of drug therapy: analgesics, β-blockers, antispasmodics,. tranquilizers, anticonvulsants, magnetic therapy. Under the influence of the prescribed treatment, no changes in the pain status occurred. Two to three times a day, especially at night, narcotics were administered. 02.10.83 to start the pain, the electroneurity of the shock began. It was found that the maximum effect of suppressing pain in the phantom gave the placement of the active electrode over the place of truncation of the sciatic nerve, and the passive one - 10 cm more proximal along the course of the nerve. Cult pain was best resolved by placing the active electrode in the focus of the painful area. The most pronounced effect of pain suppression is observed at a current amplitude of 45 mA. When the amplitude decreased, the analgesic effect decreased and completely disappeared at 30 mA. The amplitude value of the current, equal to 45 mA, could only be achieved by reducing the duration of the pulses to 100 ISS and decreasing the frequency of their pulses to 70 Hz. LI with a current amplitude of 45 mA for pulse durations of 100 µs and a frequency of 70 Hz, although it did bring substantial relief, but the pain did not disappear completely. The effect of suppressing pain was extremely unstable and ceased almost immediately after turning off the stimulator. 10/09/83 with front access under the control of a searchable electronic device, a catheter is connected to the first nerve. The catheter introduced 70 ml of 0.1% lidocaine solution. The pain in the cult was stopped. After the start of stimulation, the pain in the phantom disappeared. Neural symptoms and local autonomic disorders completely disappeared after 4 days. By the end of the week, pain in the intervals between the administration of anesthetics and stimulation ceased to occur. Remission achieved.

The positive effect of the invention is confirmed by the fact that the post-amputation pains, when applied, stop completely after 2-3 days, in contrast to the known methods, in which the duration of treatment is 3-4 weeks and requires from 60 to 100 procedures. The positive effect of the proposed method is explained by the following E1Lm: low concentrations of local anesthetic selectively act on nerve fibers, blocking only thin nerve fibers that are directly related to the conduction of pathological pain impulses, without disturbing the conductivity of thick fibers — conductors of normal sensory signals that inhibit effect on pain impulses. Besides,

76.9 + 6.3 22.7 + 1.2 R 0.05

70.0 + 9.9 8.0 + 0.76 P 0.05

1.4 + 0.71 1.63 + 0.23, 05

14.5 ± 1.43 2.6 + 0.2, 05

24.3 ± 1.9 7.7 + 1.2, 05

Editor M. Tsitkina

Compiled by T. Trushina

Tehred I. Veres Proofreader T. Kolb

Order 4854/3 Circulation 660 Subscription

VNIIPI State Committee of the USSR

for inventions and discoveries 113035, Moscow, Zh-35, Raushsk nab., 4/5

Production and printing company, Uzhgorod, Projecto st., 4

1256753

Electrostimulation under conditions of a differentiated block of fine fibers has a more powerful effect not only on spinal, but also on supraspinal mechanisms of pain inhibition.

A comparison was made of two groups of patients compared in severity and duration of the disease, clinical forms, age and other signs. The first group (20 patients) received treatment according to a known method, the second group (36 patients) - according to the proposed method.

1.4 + 0.71 1.63 + 0.23, 05

Claims (1)

METHOD FOR TREATING POST-AMUTATION PAINS, including anesthesia and electrical stimulation of nerve trunks, characterized in that, in order to reduce the treatment time, anesthesia is performed by exposure to thin nerve fibers with an 0.1-0.25% anesthetic solution, and thick electrical stimulation is carried out simultaneously nerve fibers * „..1256753 1,125