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SURGICAL TREATMENT OF COCCYGODYNIA


By • Дек 26th, 2010 • Category: Anus

Coccygodynia is characterized by pain in the coccy-geal region when sitting or application of pressure is due to a previous single or continual trauma of the coc­cyx. The surgical methods for treating this condition include novocain block and coccygectomy. A short novo-cain block according to Vishnevsk’y is obtained by in­jection around the coccyx and into its dorsal and vent­ral surfaces (Fig. 109,3) of 30—40 ml of 0.25 per cent novocain solution from three punctures (one at its apex and two near the coccygeal margins) (Fig. 109,1 and 109,2). A total of 150 ml of novocain solution is required. A 0.5 per cent novocain solution containing 0.1 per cent of methylene blue has a more prolonged action. In the latter case the maximum dose of anesthetic is 80 ml. After the block, an ointment compress of two layers of oilcloth and cotton-wool is applied to the coc­cygeal region. The compress is renewed in two days’ time after a bath and left in place for two days more. The block is repeated in 10 days,

Operation for coccyx extirpation in coccygodynia. This operation is resorted to in severe cases of coccygo­dynia. Under combined inhalation anesthesia, a medial incision is made to expose the ventral coccygeal surface, the lateral ligaments of the coccyx are severed (Fig. 110,1), and its ventral surface is laid bare with a knife and raspatory, starting from the apex. A wide spatula is inserted under the coccyx, which is then freed clean from the sacrum by means of a broad straight scoop and mallet (Fig. 110,2), A balsamic ointment is poured into the wound (Fig. 110,3), and the skin completely closed with widely spaced silk sutures. The sutures should be removed in 12—13 days.

Treatment of coccygodynia with novocain block

Fig. 109 Treatment of coccygodynia with novocain block:

1. Raising novocain wheals around the coccyx.

2. Novocain solution is injected in the dorsal and ven­tral regions of the coccyx.

3. Novocain solution is injected through lateral wheals to irrigate lateral surfaces of the coccyx.



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