Nerve blocks and trigger point injection

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Nerve blocks and trigger point injection

The essence of medical procedures procaine (novocaine) or lidocaine (xylocaine, lignocaine) injection is administered anaesthetic drugs to the most painful — trigger points in the case of strained muscles and joints overloaded (trigger point injection for pain in the spine), as well as the points of passage of the anatomical location of nerves and nerve plexus.

During the therapeutic procaine or lidocaine (xylocaine, lignocaine) injection (eg injection for pain in the spine) occurs the effect of anesthesia, which may not be long in duration (20–30 minutes), but this is often sufficient, in order to activate the process of restoring a normal tone of spastic muscles.

The site of injection during the treatment procaine (novocaine) or lidocaine (xylocaine, lignocaine) injection.
The subacromial space is infiltrated with an anaesthetic drugs when subacromial impingement is the cause of the shoulder pain.

The effect of therapeutic procaine or lidocaine (xylocaine, lignocaine) injection appears to relieve muscle spasm Throughout muscles, increase range of motion in the joint, reducing the intensity of the feeling of pain locally or in the zone of innervation of the nerve root.

Nerve blocks and trigger point injection types

Therapeutic injections types depending on the injection point and medications type:

  • epidural steroid injections (pain in the spine, extending to the leg)
  • transforaminal selective injection of the nerve roots
  • injection with osteoarthritis of the intervertebral joints (spondylarthrosis with pain in the spine)
  • injection of the sacroiliac joint (pain in the lower back and sacrum)
  • injection of joints hormones (Kenalog, Diprospan, hydrocortisone)
  • injection of trigger points
  • injection autonomic trunks, ganglia and plexuses
Localization of the typical pain points in the muscle pain (trigger point, fibromyalgia).


Indication for nerve blocks and trigger point injection procedure

Here is a list of some typical diseases that require treatment including with therapeutic injection:

Injections of the medication (with local anaesthetic drugs and corticosteroids) into the cavity of the temporomandibular joint.


Contraindication for nerve blocks and trigger point injection procedure

  • sick sinus syndrome
  • marked bradycardia
  • atrioventricular block grade 2 and 3 (except when a probe to stimulate the ventricles)
  • cardiogenic shock
  • severe hypotension
  • myasthenia
  • increased individual sensitivity to lidocaine (xylocaine, lignocaine) or procaine
  • a history of epileptiform convulsions caused by lidocaine (xylocaine, lignocaine) or procaine (novocaine)
  • severely impaired liver function


Lidocaine (xylocaine, lignocaine) usage, side effects and dosing for nerve blocks and trigger point injection procedure

For infiltrative anesthesia using 0.125%, 0.25% and 0.5% lidocaine (xylocaine, lignocaine) solutions. The maximum total dose of 300 mg of lidocaine (xylocaine, lignocaine) (60 ml of 0.5% solution). For conductive anesthesia using 1% and 2% solutions. The maximum total dose up to 400 mg (40 ml of a 1% solution or 20ml of 2% lidocaine (xylocaine, lignocaine)). For the injection of nerve plexus 10–20ml of 1% solution or 2% solution 5-10ml.

Corticosteroids and local anaesthetic drugs injection used for treatment.

For epidural 1 % and 2 % solutions (not more than 300 mg of lidocaine (xylocaine, lignocaine)). For extension of lidocaine (xylocaine, lignocaine) can be added ex tempore 0,1 % epinephrine solution (1 drop per 5–10 ml lidocaine (xylocaine, lignocaine), but not more than 5 drops of the entire volume of solution). For the prevention of arterial hypotension and collapse during spinal anesthesia is administered pre 1ml of 5 % solution of ephedrine hydrochloride intravenously.

General guideline for needle sizes used in therapeutic blocks: 22-gauge to 25-gauge needles are larger in diameter and are used for deeper injections or injecting thicker medications. 27-gauge and more are smaller needles and are preferred for more superficial injections or when minimizing discomfort is a priority.

For terminal anesthesia of mucous membranes (in dentistry, in the preparation and conduct of endoscopic studies) used no more than 2 ml of 10 % lidocaine (xylocaine, lignocaine). For anesthesia mucous membranes (for intubation, bronhoezofagoskopii, removal of polyps, maxillary sinus punctures, etc..) Using 1% and 2% solutions, less a 5% solution of no more than 20 ml. In ophthalmology: 2%–4% solution instilled into the conjunctival sac 2 drops 2–3 times at intervals of 30-60 seconds immediately prior to surgery or investigation.

Syringe size is typically chosen based on the amount of local anaesthetic needed for the specific block. Common sizes are 1 ml, 3 ml, 5 ml, and 10 ml.

As the antiarrhythmic agent, lidocaine (xylocaine, lignocaine) injected first jet (within 3–4 min.) On the average dose of 80 mg (50–100 mg), and then continue to enter the drip averaging 2mg per minute. Infusion duration depends on the patient and the results of the drug. 6 ml infusion diluted 2% lidocaine (xylocaine, lignocaine) in ampoule 60 ml isotonic sodium chloride solution containing 2 mg in 1 ml. Enter also initially intravenously 80 mg while intramuscularly (into the gluteal or deltoid) 400 mg (4 ml of 10 % solution); then every 3 hours — intramuscular injection of 200–400 mg (2–4 ml 10% solution).