Paranephric block

Indications for the procedure

Perirenal blockade is used for a wide range of acute surgical and therapeutic conditions. The main objective of the manipulation is to relieve severe pain syndrome and spasm.

Key indications include:

• Relief of renal and biliary colic.
• Inflammatory diseases of the hepatobiliary zone: cholecystitis, biliary dyskinesia, pancreatitis.
• Acute abdominal conditions: peritonitis, exacerbated gastric ulcer, dynamic intestinal obstruction.
• Vascular pathologies: early stage of obliterating endarteritis.
• Anti-shock therapy for severe lower limb trauma.

Topographic landmarks and patient positioning

The success of any topographic-anatomical manipulation begins with proper patient positioning. To perform a paranephric block, the patient must be placed on the healthy side. A mandatory condition is placing a firm bolster under the lumbar region. This position maximizes exposure to the target area.

Finding the injection point requires precise knowledge of projection anatomy. The physician identifies two key structures:

1. Lower border of the 12th rib.
2. Lateral edge of the erector spinae muscle (m. erector spinae).

The intersection of these two lines forms an angle. The apex of this angle serves as the site for inserting the long needle. The needle must be directed strictly perpendicular to the patient's body surface.

Injection technique and success criteria

The needle insertion process itself requires extreme concentration from the surgeon. The needle is advanced deeper into the tissues while continuously injecting 0.25% procaine solution. This technique allows safe tissue dissection ahead of the needle tip.

The anatomical goal of the manipulation is to pass through the retrorenal fascia and enter the free paranephric cellular space.

How can the surgeon ensure the needle has reached the correct layer? The primary and most reliable criterion for correct needle placement is the cessation of backflow of fluid from the hub. While the needle is passing through dense tissues, the injected solution tends to flow back. However, as soon as the needle bevel enters the perirenal adipose tissue, the backflow stops completely.

Having confirmed the correct position, the physician injects the therapeutic dose of the anesthetic—from 60 to 80 ml. It is extremely critical to remember that to achieve a full effect, the block is always performed bilaterally.

Complications and precautions

Despite its high clinical efficacy, paranephric block is considered a high-risk manipulation. Due to the frequency of potential complications, strict indications are applied to the procedure.

During the needle advancement process, the following errors must be strictly avoided:

• Damage to the renal parenchyma. Needle insertion that is too deep or deviated from the perpendicular can lead to injury of the organ tissue.
• Injection of procaine under the renal capsule. If the solution enters beneath the capsule rather than the free adipose tissue, it will cause acute stretching of the capsule.
• Damage to renal vessels. Wounding major blood vessels is fraught with hemorrhage.
• Penetration of the needle into the intestinal lumen. In case of gross violation of landmarks, there is a risk of puncturing the ascending or descending colon.

باختصار: إجابات عن أسئلة حول الموضوع

أسئلة من المحاضرات والامتحانات

مواضيع أخرى للمراجعة في نفس السياق

• Topographic anatomy of the retroperitoneal space and renal fasciae.
• Mechanism of action of procaine in relieving renal and biliary colic.
• Pathogenesis of shock in severe lower limb trauma and the role of regional blocks.
• التشخيص التفاضلي للحالات التي تتطلب حصاراً حول الكلية (التهاب Peritonitis، التهاب البنكرياس Pancreatitis، انسداد الأمعاء).
• التكتيك الجراحي في حال الإصابة العرضية لأوعية الكلية أو القولون.

مواضيع أخرى في قسم «عمليات أعضاء الحيز خلف البريتوان»

تم إعداد المادة بواسطة أعضاء هيئة التدريس في WhiteCoat Pro وفقاً للمنهج الدراسي لكليات الطب. وهي ذات طابع تعليمي.