Neck blockade Vagosympathetic according to Vishnevsky

The medicinal blockade of the cervical vertebrae of the sympathetic trunk, along with the vagus nerve, is called the "vagosympathetic blockade." It was prescribed by Aleksandr Aleksandrovich Vishnevsky with the intention of interrupting nerve impulses during pleuropulmonary shock due to traumatic disorders and injuries of the thoracic zone.

Gives a stable positive result in inflammatory diseases and various ailments of muscle tone.

The neocaine blockade was tested by S. G. Zohrabyan in order to recognize the hypotensive syndrome of traumatic origin. Observations were made on experimental brain trauma, in which the blockade of cervical sympathetic nodes in animals with cerebral hypotension can lead to an increase in intracranial pressure for a short time. The headache is reduced in 80% of cases after this procedure. But the result lasted only a couple of hours. This is due to the fact that the blockade temporarily removes the spasm of the brain vessels, as a result, the blood supply to the brain improves.

What is the procedure based on?

The blockade of vagosympathetic is a method of non-standard pathogenetic treatment based on:

• On a short-term stopping of peripheral nervous patency.
• On the reaction of an unenriched solution of novocaine on the signaling functions of the central nervous system (CNS).

Advantages of blockade

According to these provisions A. Vishnevsky came to some conclusions:

• For various reasons, the process of inflammation at the beginning of its growth is subject to the same laws.
• The growth of the process of inflammation can be stopped while he is at the stage of serous tissue impregnation.
• The severe form of inflammation is very quickly limited, suppressed and resolved, and a weakly transmitted form is detected.
• Infiltrative, acute and other chronic forms of inflammation are expressed by trophic shifts, sometimes rapidly resolved.
• Diseases associated with pathological changes in the work of organs. The mild irritation of the nervous system, which is performed by the cervical vagosympathetic block, removes the organ from the altered state. In this case, the blockade in such processes affects multifunctional: it allows spasm, restores the work at paresis.
• Processes of a pathological nature that are caused by changes in work and the passage of capillaries, novocaine blockade leads to correction of the physiological position of the vascular wall.

What types of blockades exist?

Let's consider this issue in more detail. The main types of blockades:

• Blockade of the fracture site of long tubular bones.
• Shoulder blockade of the shoulder.
• Thoracic blockade of the lower leg.
• Blockade of cross section.
• Blockade of the femoral nerve.
• The sciatic nerve.
• Tibial nerve.
• The fibular nerve.
• Intercostal conductor blockade.
• Paravertebral block.
• And of course, the cervical vagosympathetic.

Vagosimpathetic blockade: indications

Indications of cervical vagosympathetic blockade are also:

• Pleuropulmonary shock.
• Numerous fractures of the ribs.
• Open, closed and valvular clusters.
• Burns of the respiratory tract.
• Postoperative pneumonia.
• Syndromes of traumatic suffocations.
• Syndromes of fatty blockages (pulmonary form).

Most often, when these pathologies occur, a procedure is performed.

In order for the Vagosympathetic blockade to be performed according to Vishnevsky's method, it is necessary to know the clumsy-anatomical connections of the sympathetic trunk and the vagus nerve. These tumors are located above the hyoid bone in one cell area, which explains the probability of synchronous blocking when novocaine is administered here. Below, they are separated by a parietal leaflet of the fourth fascia.

Preparation of the patient

Before the blockade begins, the doctor examines the inscription on the vial or ampoule with an anesthetic. The patient must necessarily be in a supine position, because the occurrence of various complications can not be ruled out due to the action of anesthesia. Before surgery, the skin is always treated with an antiseptic solution. The blockade also requires this. Treatment must be carried out on a mandatory basis, since it is impossible to allow pathogenic microorganisms to enter the puncture site.

After that, the area of the skin should be covered with sterile underwear.

What happens next?

The patient is placed on his back, and a roller is placed under the shoulder blades. The head is turned to the other side of the blockade. The hand of the patient from the side of the blockade is pulled down. On the posterior border of the right sternocleidomastoid muscle, about 1-1.5 cm above the skin, 1-2 ml of 0.25-5% anesthetic solution are injected above the skin. If the shape of the jugular vein is not visible, then the location of the needle is predetermined by the level of the upper edge of the thyroid epiglottis.

How exactly is the vagosympathetic blockade carried out?

The technique is unique, only specialists of the highest qualification conduct it. With the index finger of the free hand, the muscles and blood vessels are moved inside and probed the initial surface of the vertebrae of the cervical region. Further at the end of the finger, a large needle is inserted and moved inside, toward the initial surface of the vertebrae. In the process of introducing a needle with a small volume, 2-3 ml each, an anesthetic solution for anesthetizing the procedure is additionally administered. After the end of the needle touches the vertebrae, an aspirate test is performed (to avoid intravascular injection of an anesthetic). After making sure that the blood does not get into the syringe, slowly inject 30-60 ml of 0.25% anesthetic solution. Then the needle is pulled out, and the injection site is pressed with a sterilization gauze pad for 1-2 minutes.

If strictly adhere to and follow the rules of carrying out the vagosympathetic blockade, the anesthetic solution fixes the vagus nerve and other nerves that depart from the cervical nodes of the sympathetic trunk.

Symptoms after the procedure

Effectively carried out blockade vagosympathetic in the patient causes the following symptoms:

• Ptosis (descent of the upper eyelid).
• Myos (narrowing of the pupil).
• Enophthalmus (the confluence of the eyeballs inside, the triad of Horner).
• Redness of the face and mucous membranes of the eyes.
• Pericorneal injection of vessels.
• Reduction of sweating from the side of the blockade.

The septal vagosympathetic blockade according to Vishnevsky suppresses pain, reflexes of cough, tones up the circulatory system and increases blood pressure.

Blockade can not be done from both sides at once. The time interval between the procedures should be at least 30-40 minutes. Adrenaline should not be added to the anesthetic solution during the procedure.

What are the reasons for such restrictions? The fact that you can accidentally achieve paralysis of the breath due to the blockade.

Complications

After the procedure, complications can also arise:

• Disturbance of the carotid artery during piercing.
• Violation of the internal jugular vein.
• Disorders of the esophagus.

The probability of development of atony and paresis of the intestine (such complications do not need special treatment).

All this can provoke a cervical vagosympathetic blockade according to Vishnevsky. We examined the testimony to it.

Alternative

Another intervention on the neck parts requires access, that is, the dissection of each layer of the skin. To implement access to the neck, it is necessary to maintain hygiene, since it is an open part of the body. Because of this, the neck is cross-accessed along Kocher, running along the transverse folds of the skin. Sutures after surgery in this case are usually invisible. When performing surgery on parts of the neck with longitudinal location, a longitudinal incision is often used along the anterior or posterior edge of the sternocleidomastoid muscle. Particularly noticeable are the sutures after the median longitudinal incision. Vagosimpathetic blockade (the technique is quite common) will help to avoid this operation.

With your health, you do not have to joke, you must follow safety techniques and do not lose vigilance. Then various unpleasant accidents can be avoided.