Therapeutic blockade technique in gluteus syndrome

FIELD: medicine.

SUBSTANCE: technique involves localisation of a trigger in gluteus, its borders and volume. It is pressed with increasing effort 3 to 15 kg within 3-5 minutes. Then above its location, novocaine is injected intracutaneously to form "citron". Thereafter, a needle is delivered towards the centre of the trigger with introducing 0.25%-0.5% novocaine in the volume exceeding that of the trigger along the needle. 0.2 mg of dexamethasone and 10 mg of vitamin B12 are added per each 1 ml of the introduced solution.

EFFECT: technique improves clinical effectiveness due to fast and reliable pain management.

2 ex

 

The invention relates to medicine, in particular, neurology, and is designed to treat patients in the presence of the syndrome of the gluteal muscles.

It is established that radicular pain for quite a long, for example, in the lumbar osteochondrosis can be localized only in the gluteal region. Often the pain is accompanied by formation of local seals muscle tissue with localized pain caused by tension or pressure. Call these painful lumps myogenic trigger point, area, trigger (Ivanchev GA Manual medicine. M: OOO Medpress", 1998, pagination 126). Trigger characterizes the functional and morphological substrates with clinical manifestations: pain, visceral dysfunction, impaired vascular tone, secondary disorders of microcirculation, trophism. Chronic myofascial pain are the main causes of disability in the production. The study of triggers provide tactile and deep palpation of normal and affected area with identification of the localization of painful muscles, the contours of the site and the most stressful part (Ivanchev GA ibid, p.131-132). Elimination of myofascial trigger is pathogenetic treatment and prevention (Ivanchev GA ibid, p.131-132). Thus, the detection of the trigger in the gluteal muscle,including the presence of several symptoms, you can call a syndrome of gluteal muscles, and the need to address it prompted us to develop more effective treatment method.

There is a method of treating trigger on the RF patent №2105537, including location, painful muscular seals, holding pressure, starting with the proximally located seals in order all the muscle power of the spiral, which are muscle seals. Pressure each sealing begin with efforts 3-4 kg to the disappearance of acute pain.

The disadvantage of this method is the lack of signs of improving quality of care through more rapid and lasting pain relief for the trigger.

There is a method of treatment of patients with acute and chronic pain syndromes according to the patent of Russian Federation №2234314, including epidural introduction non-steroidal anti-inflammatory drugs group oxycam in dosages for parenteral use. For treatment of radicular pain of discogenic the lumbosacral epidurally administered 20 mg of tenoxicam or 8 mg lornoksikama dissolved in 10-20 ml of saline daily for 5 days. In the treatment of chronic pain syndrome unsuccessful surgeries on the spine of epidurally administered 40 mg of tenoxicam or 16 mg lornoksikama, the solution is reported in 15-30 ml of physiological solution, daily for 5-8 days. The method allows to increase the effectiveness of the treatment, to achieve significant regression of pain and remission due to the impact on various naciaganie zone and the elimination of a number of sociogenic structures.

The disadvantage of this method is the possibility of its application complications in the Central nervous system, as well as the absence of signs of improving quality of care through more rapid and lasting pain relief for the trigger in the gluteal muscle.

The known method blockade with piriformis syndrome, involving the introduction of a needle through the skin into the belly of the piriformis muscle, layer-by-layer infiltration anesthetic and the introduction of 10 ml of analgesic medication in the muscle (Kogan OG, Petrov astray freight, Schmidt I.R. Therapeutic drug blockade in spinal osteochondrosis. Kemerovo publishing house. 1988. S.112-114).

The disadvantage of this method is the lack of signs of improving quality of care through more rapid and lasting pain relief for the trigger in the gluteal muscle.

There is a method of relieving pain in the lumbar osteochondrosis by the RF patent №2145505, including the impact on trigger points. While palpation of trigger points in muscles perform finger, trigger points alternately fixed and C is under the control of the finger in the exact center of the fixed trigger point needle and based on the response of tissues metered volume of injected solution of novocaine.

The disadvantage of this method is the lack of signs of improving quality of care through more rapid and lasting pain relief for the trigger in the gluteal muscle.

The closest in technical essence and the achieved result is the method according to the patent of Russian Federation №2145505, the disadvantages described above and which is taken as a prototype.

The technical result consists in increasing the quality of treatment by more rapid and lasting pain relief for the trigger in the gluteal muscle.

The technical result is achieved by the fact that the way medical blockade syndrome gluteal muscles include the localization of the trigger in the gluteal muscle, its boundaries and volume and the introduction in its center through a needle of 0.25-0.5% solution of novocaine. After locating the trigger carry out his pressure with increasing force from 3 to 15 kg over 3-5 minutes. Then over the site of its location intradermally injected a solution of novocaine, to education "lemon peel". After that, the needle is carried out in the direction of the center of the trigger, exercising along with the needle introduction solution of novocaine in excess of the volume trigger, with the addition of 1 ml of injectate 0.2 mg of dexamethasone, and 10 mg of vitamin b12.

A specific example of the method. Direct palpation check the activity of the berries is offered by the muscles and define its boundaries localization and volume trigger. A particular patient trigger is located in the center of the right middle gluteal muscle. The size of the trigger value of 2×2×2 cm (8 cm3). Are pressure seals with increasing force from 3 to 15 kg over 3-5 minutes. Pressure is the impact on the soft tissue, acupressure (Ivanchev GA Manual medicine. M: OOO Medpress", 1998, p.87-88). When you save the pain outline the point of insertion of the needle into the skin over the center of the trigger. Intradermally injected with 0.25-0.5% solution of novocaine over the area of the seal to the formation of the "lemon peel". The end of the needle through the skin puncture is carried out in the center of the trigger with the introduction of 9 ml (which is larger than the trigger) 0.5% solution of novocaine with the addition of 1.8 mg of dexamethasone and 90 mg of vitamin b12(based on 1 ml of injectate 0.2 mg of dexamethasone, and 10 mg of vitamin B12).

The second example of the complete method. Palpation define the boundaries of the localization and amount of painful lumps trigger in the center of the left middle gluteal muscle, the amount of which is equal to 8×10×2 cm (160 cm3). Make pressure seals with increasing force from 3 to 15 kg over 3-5 minutes. After pressure pain persists. The skin over the center of the trigger set point of insertion of the needle and through it intradermally injected with 0.25-0.5% solution of novocaine, to education "lemon peel". Needle pierce the skin horse, the needle is carried out in the center of the trigger and enter 170 ml of 0.25% solution of novocaine with the addition of 3.4 mg of dexamethasone and 1700 mg of vitamin B 12(based on 1 ml of injectate 0.2 mg of dexamethasone, and 10 mg of vitamin B12).

The significance of differences between the invented method is the following. After determining the localization of the trigger, its boundaries and scope of the implementation of pressure trigger with increasing force from 3 to 15 kg over 3-5 minutes can improve circulation in the tissues near the trigger. Intradermal injection over the trigger solution of novocaine, to education "lemon peel" improves the accuracy of the localization of the pain and to more accurately determine the direction and depth of insertion of the needle. Holding the needle in the direction of the center of the trigger and fluids along with the needle allows you to expand the area of distribution of the liquid on the trigger. Introduction solution of novocaine in excess of the volume trigger, with the addition of 1 ml of injectate 0.2 mg of dexamethasone, and 10 mg of vitamin b12provides for the distribution of fluid on the trigger that more fully addresses the pain, relieves spasms and increases the effectiveness of the procedure. Use as infusional liquid solution of novocaine individually added per 1 ml of 0.2 mg of dexamethasone, and 10 mg of vitamin b12provides not only an analgesic effect, but also prolongs the effect of treatment for an individual patient. Thus,the combination of features of the claimed method is more rapid and persistent pain, that improves the quality of treatment.

The application of the invention it is possible in neurosurgery and experimental neurology.

Treatment blockade syndrome gluteal muscles, including the localization of the trigger in the gluteal muscle, its boundaries and volume and the introduction in its center through a needle of 0.25-0.5%solution of novocaine, characterized in that after determining the localization of the trigger carry out his pressure with increasing force from 3 to 15 kg over 3-5 min, then over the site of its location intradermally injected a solution of novocaine, to education "lemon peel", then the needle is carried out in the direction of the center of the trigger, exercising along with the needle introduction solution of novocaine in excess of the volume trigger, with the addition of 1 ml of injectate 0.2 mg of dexamethasone, and 10 mg of vitamin b12.



 

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