Technique blockade of the upper cervical sympathetic ganglia

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For the production of blockade, the patient is placed on the operating table at the back. Under blades fit the roller, and the head is lowered to the level of the table and turns in the opposite direction. At the specified position head is most extended, cervical lordosis increases, larynx, trachea, and carotid artery move in the direction of rotation; sternocleidomastoid muscle on the side of the blockade leaves vessels and nerves more open, allowing the least traumatic access to the sympathetic ganglia. The skin of the neck is processed by alcohol. To determine the point injections down from the top of the mastoid process on the leading edge of the sternocleidomastoid muscle postponed the line segment is 4-4,5 cm, the lower pole of which will correspond to the projections of the sympathetic site on the skin. Later in the marked point is intradermal injection of 0.5% solution novokaina in amount of 1-2 ml type "lemon peel". Then a needle is directed strictly perpendicularly to the surface of the skin and jerky movements pushed to the spine. Each movement of the needle predpolagaetsya introduction 1-2 ml of Novocain. Pulling up of the piston itself checks the possibility of traumatic damage of the blood vessels. The needle moves to the stop her in transverse process II cervical vertebra. Then the needle is drawn on 2-3 mm in the opposite direction, once again verified the absence of injury to the blood vessels, and then in this region enter 10 ml of Novocain (Fig. 28). After the introduction of novocaine the needle is removed, the place of injection treated with iodine, head of the patient is rotated into position "right".

Fig. 28. Conducting blockade upper cervical sympathetic gangliev (C. D. Sazonov).

Usually within 3 to 5 minutes after the introduction of novocaine on the same side of the face appears hyperemia skin, ptosis of the upper eyelid, miosis pupil and sometimes poorly defined anophthalmus is a symptom of Gomera. These effects disappear after 10-15 minutes, after which similar manipulation plays with the other hand.
In any case, we have not observed any adverse consequences of the blockade, and the patients themselves gave this procedure preference in comparison with the scraping of the uterus.
As a positive effect of the blockade was regarded such a result, when there was either a complete stop bleeding no later than the third day after the intervention, or a sharp reduction of bleeding in the first few days and full of hemostasis by the 7-th day.
When monitoring 115 patients it was found that 83 (72.1 per cent) by the third day was celebrated full stop bleeding. 32 women, whose effect was not undergone medical-diagnostic curettage. However, 22, was found glandular-cystic endometrium, 8 - small submucous nodes fibroids and polyps and 4 - atrophic endometrium.
Interesting are data colpocytology studies of patients before the blockade: all women who have been achieved had the IV reaction when KPI not less than 50%; among women who had not been achieved, IV colpocytology reaction was only 10, and the rest within III, III-II with low numbers of the CRPD, which suggests that this intervention is effective only in cases of high concentration of estrogen.
If a positive treatment effect was observed appropriate changes symptom of "maybe" and the phenomenon of "fern", increased basal body temperature by 0.3-0.4 degrees, the reduction of estrogen saturation (on cytological picture). Control the capture bar scrapings the lining of the uterus has identified the development of secretory transformations. The study of pregnandiol before and after the siege (positive effect) showed its increase compared to the initial figures 3-5 times.
The distribution of the patients who had a positive therapeutic effect of procaine blockade on the histological endometrial structure is given in table. 6.
Very indicative is the disappearance after blockade of ferrous and ferrous-cystic hyperplasia of the endometrium, and the emergence of a large number of secretory transformations.