Doctor: In your case, it is considered that small joint disorder and long-term instability cause repeated local irritation, leading to an inflammatory stimulus. In medicine, we also call it chemical nerve block: it refers to the use of lidocaine, bupivacaine and other anesthetic

When I received a consultation in the outpatient clinic, I met

a patient whose back pain had not healed for several months.

Patient: Alas! well! well! Doctor, my waist hurts so much. It has not healed after several months of treatment. How can I get it done? well! It hurts so much!

Family members: We ran everywhere and tried every possible solution. She just complained about the pain, but we couldn’t do anything. We also did physical therapy, but the medicine had no effect.

Patient: It hurts. I can't stand it anymore. Can you think of a way to stop the pain? Doctor~

Patient's family member: That's right, look at how much pain she has. What does it look like?

Doctor

Doctor: OK, OK, Let me sort it out. Have you been in pain for several months and have not been relieved by physical therapy?

Patient: Yes, yes.

The doctorAfter asking the medical history in detail learned that

the patient mainly suffered from low back pain

unparalleled lower limb pain and numbness

physical examinationfound that

the patient's lumbar hyperextension and hyperflexion had limited activity

the location of the pain was relatively local

Tenderness is obvious

Patient: Right, right Yes, that's right, that "Tata" hurts the most.

Doctor

Doctor: Have you had any examination?

Patient: Those who have been examined, hurry up, hurry up, the old man shows the film to the doctor.

After the doctor reviewed the film,

Doctor: In your case, it is considered that facet joint disorder is unstable for a long time, causing repeated local irritation, leading to an inflammatory stimulus. And if your current treatment effect is not good, you can apply a sealant to see how the effect is.

Patient: No, no, no, no fight, no fight...

Patient's family: They all said that blockade is not possible.

Patient: People say that if the disease relapses after the injection, forensic medicine is not recommended. I still want to live for a few more years, but I haven’t enjoyed the blessing yet.

Doctor: Do you know what closure is?

Patient: I don’t know.

Today I will explain to you in detail

this "local sealing treatment"

What is "closure"?

Here comes the point!

"Sealing" means literally: Seal the local pain and inflammation (that is, the most painful point in the patient's mouth), close it well, and then isolate it from the surrounding tissue.

In medicine, it is also called chemical nerve block : It refers to the use of lidocaine, bupivacaine and other anesthetic drugs, combined with corticosteroids and other drugs, to be injected into the painful area to block the sensation. , sympathetic nerve , directly blocks the painful nerve conduction pathway, improves local blood circulation, and the hormone exerts anti-inflammatory and anti-allergic effects, thereby obtaining the efficacy of eliminating inflammation, relieving pain, and improving function, and is clinically used widely used.

Which situations are suitable for closed treatment?

In the following situations, treatment may be considered.

① Acute and chronic injuries of soft tissue, such as bursitis, tenosynovitis, lumbar muscle strain, frozen shoulder , etc.

② Peripheral nerve entrapment, such as carpal tunnel syndrome , cubital tunnel syndrome , etc.

③ Arthritis, such as osteoarthritis, gouty arthritis , etc.

In the following cases, injections are not considered.

① There is infection at the puncture site or nearby skin

② Do not use hormones or anesthetics for hormones and allergy

③Have a history of recurrent gastrointestinal bleeding, especially those who have had gastrointestinal bleeding recently

④ Coagulation dysfunction, such as hemophilia

⑤Severe hypertension or diabetes

⑥ Tuberculosis

⑦Hyperthyroidism

⑧Near the injection partX The radiograph shows pathological lesions of bone or soft tissue, such as bone tumors

Do the hormones used for closure

have any side effects?

Currently, the commonly used drugs for partial closure are: local anesthetic + glucocorticoids

① Some patients worry that closure will produce hormone dependence. Here is an explanation of this dependency for these people.

Dependence: mainly refers to the fact that although the symptoms of certain diseases are completely controlled or partially relieved after using hormone therapy, the condition relapses or worsens immediately after the hormone is suddenly stopped or the dose is rapidly reduced. This situation only exists with long-term, high-dose, and repeated use of hormone therapy.

And closed therapy usually only takes 1 to 3 injections in a course of treatment, and each time there is an interval of 7 to 10 days, and the injection dose is very small, and there is basically no possibility of hormone dependence.

② Some patients feel that after taking hormones they will become full moon face , buffalo back, and may also suffer from osteoporosis fractures.

In fact, there is no need to worry about the complications of glucocorticoid application. Because the hormone is only used locally, not the whole body, and the dosage is very small, its side effects can be completely ignored for short-term application.

In short, since most of the injected drugs in closed therapy are hormones, there may be increased blood sugar, osteoporosis, , anesthetic allergy and toxic reactions in diabetic patients, and local complications such as ligament rupture and subcutaneous atrophy may also occur. However, as long as you accurately understand its indications and contraindications and follow the doctor's advice for treatment in a regular hospital, these hazards will generally not occur. What should we pay attention to when

is closed?

① In order to prevent infection, closed injection should be performed in a regular hospital. Doctors should perform aseptic operations when performing closed treatment on patients. The clean skin site should be strictly disinfected before injection, and the dosage should be strictly controlled according to the condition of the patient.

②After partial closure, the joints should be moved slowly so that the drug can be fully dispersed in the joint space and soft tissue.

③If there is swelling, redness, increased skin temperature, or body temperature exceeding 38°C at the injection site, you should go to the hospital for treatment in time to rule out infection.

④Patients with diabetes may experience a one-time increase in blood sugar after receiving a blocking injection. If the blood sugar of diabetic patients has been unstable recently, blocking treatment can be performed after the adjustment is stable.

⑤ Observe for 15 minutes after injection to prevent allergic reactions and other reactions. Pay attention to keep your skin clean within 3 days after closure to prevent contamination.

Why does

cause repeated pain after sealing?

① Some patients believe that sealing can only temporarily relieve pain and cannot fundamentally solve the problem. Although sealing therapy cannot fundamentally eliminate the cause of the disease, it can reduce or even eliminate pain symptoms and prevent complications. For example, many chronic pains such as neck, shoulder, waist and leg pain, tennis elbow, etc., after one or several closed treatments, the symptoms completely disappear and will not recur.

② However, some patients feel the symptoms are relieved after taking an injection and no longer take treatment until the next time the pain becomes obvious. In this case, the condition is often delayed due to insufficient treatment.

③ Pain relief after closed treatment is due to the temporary analgesic effect of anesthetic drugs. The pain will recover after a few hours, and the pain will be relieved again within 1 to 2 days under the action of corticosteroids.

④ For those who experience recurring pain after treatment, it may be because they did not have a good rest or due to work, the original lesion was repeatedly stimulated, causing recurring pain.

The blocking effect is so amazing

can it be blocked as long as it hurts??

Some patients have tasted the "sweetness" of isolation for the first time, or their relatives and friends are fine with isolation, and they think isolation is very powerful, so they call the doctor to perform isolation as soon as they come to the hospital.

Let me tell you, you are messing around. Because you first need to know what disease is causing your pain and whether it is suitable for closed treatment. Because closure is also a treatment method and is not effective for everyone. Therefore, if a chronic disease cannot be relieved after several closure treatments, other treatment methods are needed.

Patient: You have to have it, I understand! Then close it! Thank you

This article serves as a medical popularization of "partial sealing method". I hope that all patients will have a correct understanding of sealing therapy, a correct view of its pros and cons, and listen to the doctor's advice when it comes to treatment selection. You don't have to rush to reject sealing therapy after hearing it. .