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Diagnostic and therapeutic nerve blockade

Nerve blockade with local anesthetics is designed to treat acute and chronic pain,

and in some cases used to identify its mechanisms. The nerve block allows you to determine the interest of the sympathetic nervous system in the genesis of pain. The elimination of pain following a diagnostic blockade often has a favorable prognostic value for a series of subsequent medical blockades. Although the diagnostic value of the differential blockade in the distinction between somatic and autonomic mechanisms remains doubtful (see below), this technique allows to identify patients who respond to the administration of placebo and patients with psychogenic pain. In some cases, "permanent" nerve blockade is indicated.

The effectiveness of nerve blockade is mainly due to the interruption of the pathways for pain sensitivity.
In addition, the blockade inhibits the afferent and efferent parts of altered reflexes (visceral and skeletal muscles). The analgesic effect of the blockade can be preserved for much longer than the known duration of the action of anesthetics - for many hours and, sometimes, even weeks. The choice of method of blockade depends on the localization of pain, the proposed mechanisms and practical skills of the doctor. Methods include infiltration anesthesia, blockade of peripheral nerves, blockade of nerve plexuses, blockade of sympathetic ganglia, blockade of spinal nerve roots and central blockade. Central blockade (spinal and epidural anesthesia) is described in Ch. 16, the most common methods of peripheral nerve blockade are discussed in Sec. 17
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Diagnostic and therapeutic nerve blockade

  1. Nerve blockade of the trunk
    Blockade of the superficial cervical plexus A. Indications. The superficial cervical plexus blockade is indicated for operations on one side of the neck, for example, for carotid endarter ectomy, as well as an addition to the inter-biliary blockade of the brachial plexus from the anterior access to the shoulder joint. The blockade of the deep cervical plexus is discussed in Ch. 18. B. Anatomy. Cervical plexus
  2. Intercostal nerve blockade
    Anatomy. Twelve pairs of the thoracic nerves after exiting the intervertebral foramen and the recoil of the two branches (the connecting - to the border stem and the back - to the skin and the back muscles) go to the furrow. 37. Anatomy of the intercostal nerve. 1 — sympathetic chain; 2 — place of anesthetic administration with paravertebral anesthesin; 3 —white connecting branch; 4 — gray connecting branch;
  3. Peripheral Nerve Blockade Techniques
    During the blockade of the peripheral nerves, anatomical landmarks, infiltration anesthesia, verification of the needle position by paresthesia, sheath perivascular blockade, transarterial access, and electrostimulation of the nerve are used. 1. CORRECT INSTALLATION OF THE NEEDLE Anatomical landmarks Some types of blockades are performed strictly according to anatomical landmarks. An example is intercostal
  4. Blockade of the nerves of the lower limb
    For regional anesthesia, spinal and epidural anesthesia is most commonly used for operations on the lower limbs (see Chapter 16). Nevertheless, blockade of the somatic branches of the lumbar plexus and sciatic nerve during interventions on the lower limbs also provides adequate anesthesia. The blockade of the nerves of the lower limb is performed at the level of the hip, knee and ankle
  5. Somatic nerve blockade
    Blockade of the trigeminal nerve and its branches A. Indications. The two main indications are trigeminal neuralgia and irremovable pain in malignant tumors of the facial area. Depending on the location of the pain, a blockade of the gasserov node, or one of the main branches of the trigeminal nerve (ocular, maxillary or mandibular nerve), or small branches is shown. B. Anatomy. Triple
  6. Peripheral nerve block
    The use of regional anesthesia for operations on the limbs is not a new idea. At the end of the XIX century. Amputation of the extremities was performed after surgical exposure of the nerve trunk and cocaine application: for amputation of the arm, for the brachial plexus, for amputation of the leg, for the sciatic and femoral nerves. With the development of general anesthesia in the first half of the XX century. interest in regional methodologies is noticeable
  7. Blockade of the nerves of the upper limb
    For anesthesia during surgery on the upper limb, a blockade of the brachial plexus (at one or several levels) or its terminal branches is used. Anatomy of the brachial plexus The brachial plexus almost completely provides the somatic innervation of the upper limb. The brachial plexus is formed by the anterior branches of the spinal nerves C5-C8 and T1 (Fig. 17-1).
  8. GHG prevention during medical diagnostic interventions
    In order to prevent the possibility of GHG infection, it is necessary to maximize the use of disposable medical and laboratory instruments; strictly observe the rules of use, disinfection, presterilizing cleaning and sterilization of medical and laboratory instruments and other equipment. It is forbidden to conduct any injections, vaccinations, intradermal tests, etc.
  9. What therapeutic and diagnostic measures should be taken while the laboratory is conducting research?
    Immediate steps should be taken to prevent hypoxemia and hypoperfusion. Oxygen inhalation prevents hypoxemia and allows for increased oxygen delivery to the tissues. With hypoventilation and respiratory distress, tracheal intubation is indicated. It is necessary to often measure blood pressure. If there are no symptoms of hypervolemia, an informative test with a volume load (fast infusion of 500 ml of crystalloid solution or
  10. The combination of a complete blockade of the right leg and the blockade of the anterior-upper branching of the left leg (two-beam blockade)
    In 1934, F. Wilson et al. described three electrocardiographic cases of “atypical blockade of the right leg”, in which a significant increase in the time of internal deviation in the right thoracic leads was combined with wide and deep teeth of the SB leads III and II. After 20 years, J. Richman and L. Wolff called such a paradoxical, from the point of view of these authors, a form of conduction disturbance
  11. Combination of a complete blockade of the right leg and a blockade of the back-lower branching of the left leg (double-block blockade)
    For this rarely occurring combination, a sharp shift of the QRS electrical axis down and to the right (Za> + 100 to + 120 °), complexes rS in leads I, aVL (deep serrated S) and qR in leads II, III, aVF; however, the R-wave here is not as high as with isolated BZNR; in addition, there may be a terminal serrated tooth S in one or several lower leads; in the chest
  12. Anterograde AV blockade of the I degree, or incomplete AV blockade with lengthening of the AV time
    This form of blockade was described at the end of the 19th century. K. Wenckebach (1899), who showed that as AV conduction deteriorates, the a — c interval lengthens on the curve of the jugular venous pulse. The same phenomenon on an ECG (more in the second lead) is reflected by a lengthening of the interval P — R (Q), and each P wave is followed by a QRS complex associated with it. Total AV blockade I degree
  13. The blockade of the three branches of the bundle gis (three-beam blockade)
    A three-beam blockade is characterized by the presence of a conduction disturbance simultaneously along the three branches of the His branch. If there is an incomplete three-bundle blockade, an electrical impulse from the atria is conducted to the ventricles along one less affected branch of the His bundle. At the same time, AV conduction is either slowed down or individual pulses in the ventricles are not conducted at all. On ECG, various violations are recorded.
  14. Sinoatrial (SA) blockade, or exit blockage (exit block) from the CA node
    This term refers to conduction disturbances in which the pulses generated in the CA node are unable to overcome the CA connection or exit the CA node more slowly than normal. According to A. Castillo-Fenoy et al. (1980), the basis of this phenomenon is the deterioration of conductivity within the node itself, as a result, the resulting electrical potential does not reach the threshold level
  15. Combined blockade of two branches of the bundle gis (two-beam blockade)
    Blockade of the left leg of the bundle of His (combined blockade of both branches of the left leg) Blockade of the left leg of the bundle of His is characterized by a violation of an electrical impulse along the main trunk of the leg before it is divided into two branches or by simultaneous damage to the left front and left rear branches of the bundle of His. With complete blockade of the left leg, LV is excited in an atypical way. Depolarization wave
  16. Anterograd AV blockade of III degree, or complete AV blockade
    The loss of connection between the excitation of the atria and ventricles is the most important feature of the transverse heart block. The atrial rhythm (P teeth) is more often ventricular (QRS complexes), unlike AV dissociation, in which the independent ventricular rhythm exceeds or is equal to the atrial rhythm. Electrocardiographic and clinical signs of complete AV blockade largely depend on the level
  17. Differential central blockade and blockade of the brachial plexus
    Differential pharmacological blockade is designed to distinguish between somatic, sympathetic and psychogenic pain. The technique is based on the different sensitivity of nerve fibers to local anesthetics (see Chapter 14). The most sensitive to anesthetics are preganglionic sympathetic fibers (type B), followed by pain sensitivity fibers (type C and A5), somatosensory
  18. Anterograde II degree blockade, or incomplete AV blockade with the absence of one or several consecutive sinus (atrial) impulses
    In 1894, T. Engelman reported that he had observed on the frog's heart a progressive increase in conductivity from the atria to the ventricles, ending with the disappearance of one contraction. After 5 years, K. Wenckebach (1899) described the same phenomenon in humans and called it Luciani periods by the name of a researcher who, as far back as 1872, pointed out a similar phenomenon. In 1906, J. Hay discovered that with
  19. Advanced atrioventricular block of the second degree and blockade of the third degree of type A1
    1 According to the classification of the authors, type A indicates the AV-blockade variant with the normal form of the QRS complex, and type B - the AV-blockade variant with the extended QRS complex. - Note. translator. The term “advanced AV block II degree” is used in cases when more than two consecutive supraventricular impulses are blocked [9]. Although distinguish this version of the blockade from the AV-blockade III degree
  20. Blockade of the right leg in combination with blockade of the posterior branch of the left leg
    Etiology. The blockade of the right leg of the His bundle with BVVLN can occur as a result of sclerosis of the specialized ventricular conduction system or (like all other types of beam bundle and branch blockade) due to the pressure of calcium deposits in the aortic valve or in the mitral valve ring on the fibers of the conductive system, as well as during extensive acute anteroposeptal myocardial infarction or significant
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