Do I need to do blockade with a hernia of the spine

Blockade for a hernia of the lumbar spine is performed for the purpose of pain relief and for differential diagnosis of pathologies of the musculoskeletal system. The procedure is not indicated for all patients with a protrusion of the intervertebral disc, because it has many contraindications and risks if performed incorrectly. There are several types of spinal blockades for hernia, depending on the analgesic used and the place of administration.

In the pathology of the disc in the lumbar region, novocaine and lidocaine are more often used.

A hernia in the lumbar region in almost every case is manifested by acute pain that occurs suddenly in response to movement. The pain syndrome caused by disc pathology should be eliminated immediately, therefore, vertebrologists prescribe spinal blocks to quickly relieve pain when oral medications and local remedies do not have the desired effect.

The action of the blockade in hernia

Blockade of the spine during disc protrusion temporarily blocks pain receptors in the area of drug administration. Such a therapeutic measure is indicated for patients only when more gentle methods do not work, and severe pain affects the quality of life, interfering with the performance of daily activities. Such anesthesia is carried out by injecting an anesthetic at certain points on the back in the spinal region. The substance enters the muscles and is evenly distributed in the tissues, eliminating pain in the lower back.

This procedure also has important diagnostic value. When the cause of the pain is not visible on the CT and MRI images, novocaine blockade is performed. If after the procedure the pain subsides, the problem is in the spine, but if there are no results, the cause should be sought in a distant organ.

Blockades are performed by professionals, the procedure can be done by a neurosurgeon, neurologist, traumatologist and vertebrologist, who perfectly knows the anatomy of the spine.

With proper preparation and conduct, immediately after the injection of an anesthetic, the patient feels relief from pain, stiffness of the spinal column and muscle spasm disappear. If during the session something went wrong, the patient may experience a number of adverse reactions, which the doctor informs in advance.

Indications and contraindications

With an intervertebral hernia in the lower back, the blockade will be prescribed according to the following indications:

persistent pain syndrome;
inefficiency of local anesthesia;
intercostal neuralgia;
progressive disc protrusion;
herpes zoster;
spondylarthrosis.

Anesthesia is prescribed to patients on an individual basis for degenerative-dystrophic pathologies of the spinal column, when other conservative methods have contraindications. The disadvantage of blockades is that they can be performed no more than 3-4 times a year, and with a disc herniation, the patient experiences pain much more often.

Contraindications to the procedure:

pathologies of the circulatory system and hematopoietic organs - hemophilia, thrombocytopenia;
reduced blood pressure;
mental disorders, epileptic seizures;
diseases of the cardiovascular system;
infectious pathologies in the acute stage;
malignant neoplasms in the injection area;
hypersensitivity to certain drugs;
the period of pregnancy and breastfeeding;
cachexia, exhaustion of the body, general serious condition;
kidney failure;
taking anticoagulants.

Usually, patients are prescribed one blockade, which will be enough to eliminate pain. Less often, a course of treatment is indicated, consisting of 5-15 injections, which are performed every other week.

Advantages of blockades for disc herniation

Treatment of an intervertebral hernia of the lumbar spine is primarily aimed at pain relief, because with this pathology, the spinal roots are compressed, the tissues around the disc swell, and the nerve fibers are compressed. Having removed acute pain, it is already possible to apply other techniques aimed at restoring the structure of the damaged disc. With intervertebral hernia, patients are prescribed NSAIDs, muscle relaxants, antispasmodics, antidepressants. These drugs have a number of adverse reactions, and their long-term use is not without consequences.

When the pain becomes constant, taking medication will already be an ineffective measure that will only lead to pathologies of the gastrointestinal tract. In this case, an alternative to drug therapy will be the blockade of the intervertebral hernia.

Types of spinal blocks

Blockades are distinguished by the site of administration and the active substance. According to localization, there are epidural, paravertebral and epidural. According to the active substance, novocaine, lidocaine, mercaine and others are isolated.

Paravertebral or paravertebral blockades, in turn, are tissue, conductive, receptor, ganglinar. Tissue injections involve the introduction of a substance under the skin. Receptor injections are given into trigger zones. Conductors block the sensitivity of nerve fibers. Ganglionic - these are injections into the nerve plexuses and nodes.

Applied means for blockade of the lumbar spine:

Local painkillers (Novokain, Merkain , Lidocaine ) . Novocaine blockade is the most common, it gives effect within a few minutes after the procedure. Lidocaine is used somewhat less frequently, but it also begins to act quickly, maintaining the effect for 3-4 hours. Merkain is used extremely rarely, it begins to act only after 10-20 minutes, while having many side reactions. Among the undesirable effects from the use of local analgesics, nausea, lowering blood pressure, and an allergic reaction can be distinguished.
Corticosteroid drugs ( Diprospan , Kenalog , Dexamethasone , Hydrocortisone) . The drug Kenalog has a prolonged action, is used for blockades of the joints and spine, is administered intermittently for at least 14 days. Diprospan is a glucocorticosteroid for tissue and neural blockades. Hydrocortisone is used for neural blocks and is mixed with an anesthetic. Dexamethasone has a quick effect, but a relatively short period of action, it is injected into soft tissues and nerve fibers.
B vitamins, preparations Voltaren , Lidaza , ATP, Papain. These drugs are used as additional substances with which analgesics and corticosteroids can be mixed.

Epidural blockade is prescribed most often for pathology in the lumbar region, it has a good analgesic effect in a short time.

Before carrying out, the patient lies on his side on the side of pain. After that, an antiseptic treatment of the skin and local anesthesia are carried out. Such a blockade is performed for about 30 minutes, and for another 2 hours after the procedure, the patient is monitored by medical personnel.

The epidural view is performed with a strong pain syndrome. The injection is carried out in the area of greatest pain, for which an anesthetic drug with a contrast agent is injected. During the procedure, the doctor observes the spread of the contrast agent along the spine through a fluoroscope.

With a herniated disc, many patients experience inflammation and pinching of the sciatic nerve. To get rid of the symptoms of a chronic process, the blockade is performed directly on the nerve with layer-by-layer tissue infiltration.

Intercostal blockade is performed with irritation of the nerve roots in the cervical region. This phenomenon may be the result of osteochondrosis and traumatic injury. With a herniated disc in the lumbar region, intercostal anesthesia is almost never performed, except in cases where several herniated discs have been diagnosed.

Complications of the procedure

Each type of blockade has a risk of complications that arise due to a violation of the antiseptic conditions or the wrong choice of the injection site and the drug. The most common consequence of an error during the procedure is bleeding and hematoma formation. Infection of tissues in the area of injection occurs less frequently.

In severe cases, damage to the membranes of the spinal cord can occur.

With inaccurate administration of the substance, there is a risk of muscle damage, then myositis develops. With intolerance to the body of certain drugs, an allergic reaction occurs. Specific complications are associated with the use of hotel painkillers and corticosteroid drugs.

An adverse reaction of the procedure may be a violation of the function of the bladder, when the long-term effect of anesthesia interrupts the nerve impulses of the sacral roots. This phenomenon leads to dysfunction of the pelvic organs, in particular, the amount of urine excreted decreases.

Neurological manifestations are the result of blockages when the needle comes into contact with the nerves and spinal cord. Their compression, as well as ischemia and abscess due to physician errors, lead to neurological complications.