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注射
注射

腰痛のブロック注射の種類と方法

注射

腰が痛くて、どうにもならない時、私たちはワラをもすがる気持ちで整形外科の門をくぐります。受付を済ませてから長時間待った末に、ようやく診療室に呼ばれます。医師に症状を訴え、まずレントゲンを撮ります。

レントゲン写真を見ながら、医師は病状を説明し「とりあえず、注射をして様子を看ましょう」と、腰の骨のあたりに痛~~い注射を打ちます。注射をして20分ぐらい横になると、何だかあれほど痛かった腰の痛みが少し和らいでいます。そして医師が言います。「また一週間したら、来てくださいね」と……。

一応、この痛い注射がブロック注射と呼ばれていることは、なんとなくわかるのです。しかしこの注射がいったいどういうシロモノであるのか、イマひとつわかっていないという人は意外と多いのではないでしょうか? ひと言にブロック注射と言っても、いろいろと種類のあるのはご存じでしたか?

本記事では、このナゾに思えるブロック注射の種類や方法、効果について、ご説明していきます。
自分がどのような効果のある、どのような薬を使って治療を受けているのか、知っておくことはとても大切です。

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ブロック注射とは?

はてな

ブロック注射とは、湿布や鎮静剤の服用だけではおさまらないツライ腰痛のときに、使用する注射です。局所麻酔剤やステロイド剤を目的の神経や関節に直接、またはその近くに注入します。

一時的に患部そのものの痛みを軽減させるだけでなく、痛みによる反射的な血管の収縮や筋肉の緊張を抑えて、二次的な痛みも取り除いてくれます。この効果は、麻酔剤の効果が切れた後も続きます。

腰椎椎間板ヘルニアなどの腰痛の症状が出たときに、注射をします。一週間に一回ほど注射をし、医師の判断により4、5回続けます。その時点で効果が出ない場合は、また別の種類の治療へと移ります。

仙骨裂孔ブロック注射

腰椎椎間板ヘルニアや脊柱管狭窄症などの腰痛に、もっともよく行われている注射です。
その理由には、あまり痛くないこと、合併症が少ないこと、効果が判断しやすいことが挙げられます。だいたい、週1回の注射を2~3回続けることによって、腰痛が回復することが多いようです。

注射の方法は、ベッドでうつ伏せになりお腹の下に枕を入れます。背骨近くの仙骨裂孔から針を刺し仙骨から下部腰椎の硬膜外腔に麻酔剤およびステロイド剤を注射します。1分ぐらいで終わりますが、その後20分間は安静を取り、効果を確認してからの帰宅となります。

硬膜外ブロック注射

硬膜外ブロック注射は、脊髄の外側に存在する硬膜外腔に薬液(局所麻酔薬およびステロイド剤)を注入して神経をブロックする方法です。

悪い方の腰を下にして寝て背中を丸くしてから消毒を行います。目的のレベルを確認した後、穿刺部に局所麻酔をして、硬膜外腔まで針を進め薬液を注入します。注射の時間は、10分弱ですが、注射の後は一時間ほどベッドで安静にしていなくてはいけません。

神経根ブロック注射

神経根ブロック注射は、仙骨裂孔ブロック注射や硬膜外ブロック注射などでも、腰痛が改善されないときに行います。原因となる神経そのものに直接針を当てるために激痛が走りますが、局所麻酔薬、ステロイド剤を注入することで、劇的な改善が期待できます。造影剤を注入することで神経の走行が確認でき、原因神経の特定ができます。

レントゲン透視室でうつ伏せの状態になり、皮膚に麻酔をした上で行います。所要時間は15分ほどですが、その後約一時間の安静が必要となります。

椎間板ブロック注射

椎間板が原因でおこる腰痛に対して、椎間板そのものに針を刺し、局所麻酔薬およびステロイド剤を注入する方法です。神経根ブロック注射と同じようにレントゲン室で皮膚に麻酔をしてから行います。幾度か体の向きを変えて、モニターで部位を確認しながら椎間板の真ん中に針を進めていきます。

腰痛治療革命 第一人者が教える7つの新常識【文春e-Books】
文藝春秋 (2013-12-13)
売り上げランキング: 43,714

まとめ:ブロック注射は効果があります

ここでは、腰痛の治療としてのブロック注射の種類と方法をご紹介してきました。腰痛の度合いによって注射のレベルも上がっていくことに、ご注目ください。

  • 仙骨裂孔ブロック注射
  • 硬膜外ブロック注射
  • 神経根ブロック注射
  • 椎間板ブロック注射

ブロック注射は、飲み薬や理学療法、運動療法などでも治らず、日常生活に支障があるような場合に行います。一般保存療法と手術的治療の中間的な位置にある治療とご理解ください。

ブロック注射に頼りすぎると腰痛が慢性化し、注射のレベルも上がってきてしまいます。
できれば注射で腰痛が少し改善されたら、ストレッチなどの運動療法で筋力をつけ、腰をガードしていくことをお勧めします。日常のストレッチが腰痛予防にもなるのです。

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