RU2353366C2 - Regional upper-limb pain syndrome management - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurology, and can be used for regional upper-limp pain syndrome management ensured by autoblood 2-4 ml sampled in a syringe prefilled with dexamethasone 0.25-0.5 ml and 1% lidocaine solution 8-10 ml. Autoblood is sampled from spongy tissues of mesoscapula. The mixture is injected intraosseously in autoblood sampling point.

EFFECT: method provides improved therapeutic blocking effect ensured by complex influence on reparative regeneration of bone tissue and osteogenesis, revasculisation of muscles, ligaments, nerve trunk, vessels, reduced irritation of maximum intraosseous receptors.

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Description

The invention relates to medicine, namely to a method for the treatment of complex regional pain of the upper limb.

A known method of treating regional pain of the upper limb, including vagosympathetic blockade to block irritation in the system of cervical autonomic nodes [1]. The method is based on the introduction of an anesthetic solution into the cervical mediastinal space, possibly with a glucocorticoid. However, these blockades have a short and mainly anesthetic effect.

The technical result, the achievement of which the present invention is directed, is to increase the effectiveness of the blockade, prolong the action of the anesthetic and other medicinal substances that make up the injected mixture in local tissues, as well as increase the effectiveness of the therapeutic effect of the treatment procedure for complex regional upper limb pain.

This result is achieved by the fact that in the method of treating regional pain of the upper limb, including the introduction of a solution of drugs containing a local anesthetic, glucocorticoid and water, the solution of drugs additionally contains autoblood with components of the patient’s bone marrow, which are taken at the site of injection of the needle into the spongy tissue of the spine of the scapula into a syringe pre-filled with an anesthetic, for example lidocaine, and a glucocorticoid, for example dexamethasone, the resulting solution after mixing with water in a syringe is injected into the spongy tissue of the spine of the scapula at the site of autologous blood collection with bone marrow components, while the resulting solution contains% (wt.):

dexamethasone  0.01-0.02 lidocaine  0.8-1.0 autoblood with components bone marrow  20-40 water  rest

The proposed method is as follows. A solution of lidocaine (0.5%) produces infiltration anesthesia of the skin, subcutaneous tissue, periosteum over the spine of the scapula. Then, an intraosseous needle with a mandrel is inserted into the spongy tissue of the spine of the scapula, the mandrin is removed from the needle, a syringe is inserted into the needle, into which just lidocaine 1% - 8.0-10.0 (0.8-1.0% (wt. ) ml and dexamethasone - 1-2 mg (0.01-0.02% (wt.)). Autologous blood with bone marrow components is collected from the spongy tissue of the spine of the scapula into the syringe with the drug solution - 2-4 ml (20-40% (wt.). The syringe is removed from the needle and the contents of the syringe are mixed with water. The resulting mixture of drugs and bone marrow components is injected into the spongy tissue of the same spine of the scapula. them, for the treatment of complex regional pain syndrome of the upper limb is used intraosseous blockade in the spine of scapula - vnutrispongioznaya automielofarmakoterapiya.

Typing autoblood into the syringe with bone marrow components is a positive aspiration test, which confirms the exact location of the needle in the spongy tissue of the spine of the scapula. This means that the cortical layer of the spine of the scapula is completely penetrated and decompressive perforation of the spongy tissue and bone marrow is performed, which leads to the normalization of intraosseous pressure. Increased intraosseous pressure, as is known, leads to an exacerbation of pain and other clinical manifestations of neuroorthopedic diseases. It is also known that in neuroorthopedic diseases, changes in bone tissue are characterized by the development of osteoporosis or osteopenia with a decrease in intraosseous blood flow. Dosed perforation of the bone tissue of the spine of the scapula, the introduction of bone marrow suspension into the spongy tissue of the spine of the scapula with complex regional pain of the upper limb stimulates reparative regeneration, enhances the metabolism and revascularization of bone tissue and segmental neuromuscular and other peripheral structures. In addition, the spongy tissue of the spine of the scapula has a rich innervation, therefore, the introduction of anesthetic into it allows you to block a large receptor field, which leads to a more significant reduction in pain and other manifestations of the complex regional pain of the upper limb.

The use of autologous blood with bone marrow components allows 3-6 times, compared with known methods, to prolong the action of anesthetic and glucocorticoid in local tissues, which increases the anesthetic effect of intraosseous blockade.

It is known that of all methods of autohemotherapy, the most effective is the one in which autologous blood is collected from a vein, hemolized and administered intravenously. The composition of the blood collected from the spongy tissue of the spine of the scapula includes not only peripheral blood cells, but also bone marrow, including stem cells. Therefore, intraosseous autohemotherapy with bone marrow components has a more pronounced immunomodulating effect.

Thus, the removal of bone marrow components from the spongy tissue of the spine of the scapula and their subsequent introduction into the spongy tissue of the spine of the same scapula with anesthetic and glucocorticoid is not just an autohemotherapeutic procedure, but essentially an intraspond decompressive automyelopharmacotherapy.

Clinical example.

Patient M., male, 33 years old. He entered the clinic with complaints of excruciating pain, numbness in his right hand. 6 months ago he suffered a dislocation of the right shoulder, after removing the plaster cast, pain appeared in the right hand, which gradually intensified and led to a limitation of the function of the arm, trophic disorders. He was treated on an outpatient and inpatient basis, received analgesics, vitamins, physiotherapy, and mas. The treatment was ineffective.

At admission: general condition of moderate severity. Somatic status within the age norm.

Neuroorthopedic status. Pain on a 10-point visual analogue scale - 9 points. Soreness and limitation of the function of the shoulder, elbow and wrist joints. Hypesthesia with a hyperpathic tinge on the outer back surface of the right forearm and hand. Reflexes from the biceps and triceps muscles of the right shoulder are reduced. The tone and strength of the extensors of the right forearm and hand are reduced.

Radiographs show signs of arthrosis of the right shoulder joint.

Thermal imaging studies before treatment showed a significant decrease in temperature in the right hand and hand - 2 ° less than in the left hand.

Diagnosis: complex regional pain syndrome of the right upper limb.

The patient underwent the following treatment: diclofenac, ultrasound with hydrocortisone, massage, physiotherapy exercises, which turned out to be ineffective. Three intraosseous blockages were made in the spine of the right scapula.

Intraosseous blockade was performed after 3-4 days. For the first blockade, the drug solution contained 10 ml of 0.01% (wt.) Dexamethasone, 0.8% (wt.) Lidocaine and 20% (wt.) Autologous blood with bone marrow components, the rest was water. After the first intraosseous block in the spine of the right scapula, the pain syndrome regressed to 2 points for 5 hours. When treating a prototype of a similar disease, the anesthetic effect lasts for 1-1.5 hours. When the prolonged anesthetic ended, the pain returned to 5 points. For the second blockade, the drug solution contained 10 ml of 0.02% (wt.) Dexamethasone, 1.0% (wt.) Lidocaine and 30% (wt.) Autoblood with bone marrow components, the rest was water. After the 2nd intraosseous blockade in the spine of the scapula, the pain syndrome regressed to 1 point, after 5 hours the pain returned to 3 points. For the third blockade, the drug solution contained 10 ml of 0.02% (wt.) Dexamethasone, 1.0% (wt.) Lidocaine and 40% (wt.) Autoblood with bone marrow components, the rest was water. After the 3rd intraosseous blockade in the spine of the scapula, the pain syndrome regressed to 1 point, after 5 hours the pain returned to 2 points.

After treatment, the following neuroorthopedic status was observed: mild soreness and slight restriction of the function of the shoulder, elbow and wrist joints. Light hypesthesia of the dorsum of the right hand. The tone and strength of the extensors of the right hand are slightly reduced.

After treatment, the patient evaluated his pain syndrome on a 10-point visual analogue scale - 1 point.

In a thermal imaging study after treatment, a significant temperature recovery in the right arm was noted. The temperature of the right hand was 0.2 ° lower than that of the left hand.

Thus, in a patient M. with severe complex regional pain of the right upper limb, intraosseous blockade in the spine of the scapula was very effective.

Information sources

1. Lobzin S.V. Puncture and blockade in neurology. St. Petersburg, 2005, p. 114, 128.

Claims (1)

A method of treating regional pain of the upper limb, comprising administering a drug mixture comprising a local anesthetic and a glucocorticoid, characterized in that 8-10 ml of a 1% lidocaine solution is administered as a local anesthetic, 0.25-0.5 ml of dexamethasone is administered as a glucocorticoid moreover, the mixture additionally contains 2-4 ml of autologous blood, the sampling of which is carried out from the spongy tissue of the spine of the scapula into a syringe pre-filled with dexamethasone and 1% lidocaine solution, the mixture is introduced into the place of auto rovi.