Important points to consider in neural therapy injections.

It is of great importance that the patient is in a comfortable and safe position for the safest administration of injections. A position that does not cause discomfort should be preferred without the need to move the patient to a different position for each injection.

The most important factor for physicians applying neural therapy is to reach the target correctly by using standardized positions for injections. The supine (dorsal) position is a suitable option for all injections in the anterior (ventral) and lateral (lateral) body parts. A comfortable sitting position on the examination table is recommended for injections in the back of the body, from the head to the coccyx, while a lateral position should be preferred for injections in the dorsal areas of the lower extremities.

Disinfection

As a basic principle, the skin should be disinfected before each injection. However, based on practical experience with procaine, no increase in infection has been observed even when the disinfection time was not observed. Injections into joints and peridural spaces with a low risk of dura injury should be performed under aseptic conditions. The risk of infection at the injection site is very low due to the strong perfusion-enhancing effect of diethylaminoethanol.

Injection Practice in Neural Therapy

Each injection should be as painless as possible. It is recommended to perform the injection with a freely supported hand. In unsupported injections, there is a risk of injecting the needle in the wrong place and injury to the patient.

In order to reach the correct injection site, the syringe must be advanced slowly as the cannula travels deep into different tissues (e.g. paravertebral trunk, prevertebral ganglion or retroperitoneal space of the small pelvis). If a low simultaneous infiltration is achieved by applying a slight pressure to the plunger, the process reduces the patient's pain. It is therefore recommended to use disposable cannulas that are replaceable, sharp and as thin in diameter as possible.

The neural therapist must learn to use the syringe and cannula with one hand. This seemingly simple procedure can lead to unwanted injections if not performed correctly. In addition to applying local anesthetic to anatomical structures, the injector also acts as a “sensory” for different tissues with a precise injection technique.

Side Effects and Risks of Neural Therapy

It is important to inform the patient not only about the potential risks, but also about the meaning of the injections. It should be clearly communicated to the patient that there may be a possible “shooting” pain in the peripheral nerves during the injection.

During the injection, great importance should be attached to the patient's feedback about the pain, as this feedback may indicate that the needle is in the wrong position. If severe pain is felt, the injection should be stopped immediately and the needle position checked and corrected.

As a basic principle, every patient should be kept under the maximum possible medical supervision after neuraltherapeutic treatment for the duration of the effect of local anesthetics.

Expected reactions include dizziness, mild sensory impairment and short-term motor deficits, while unexpected conditions such as vasovagal circulatory disorders and early allergic reactions should also be considered.

Complications of Neural Therapy

Complications should never be ignored; every complication that occurs during treatment should be carefully recorded.

Intravenous (Intra-Arterial) Injection

Intravenous injection of a local anesthetic is a rare but serious complication that requires immediate medical attention. This is usually due to improper application of the double aspiration technique with 180° needle rotation.

Anaphylaxis

Anaphylaxis, which is extremely rare, can occur regardless of the injection technique and requires emergency intervention in a hospital setting.

Bleeding and Hematoma

Hematomas are complications that require conservative treatment or rarely surgical intervention, depending on their location and extent. During conservative neural therapy, early and repeated infiltrations with procaine are performed as early as possible to promote faster resorption of the hematoma and to prevent infection.

Organ Injuries

Organ injuries that can be caused by a needle (e.g. lung, kidney, liver) usually do not require surgical intervention. However, in case of doubt, it is important to hospitalize the patient for observation. Such complications can occur due to anatomical and topographical variations as well as injection errors.

Spinal Dura Mater Ponsion

Inadvertent perforation of the spinal dura mater during peridural infiltration is a rare complication. This is more commonly observed during spinal or paraspinal anesthesia applications and can cause post-spinal headache, which usually lasts for several days.

Local Anesthesia Dosage in Neural Therapy Applications

The maximum dose of 1% procaine solution is 500 mg for extravasal administration (equivalent to 50 ml of 1% solution). However, such a high amount is not usually required in neural therapy applications. There is no need to exceed the upper limit of 15-30 ml per session. If in some cases it is necessary to exceed this limit, a break of ½-1 hour between the first and second injection is appropriate. The aim during treatment is to deliver as low a dose of procaine as possible to the target tissue with a careful injection technique.

Exposing the tissue to excessive amounts of procaine is actually a mistake that should be avoided.

Dr. Hüseyin Nazlikul
President of BNR and IFMANT

Sources Utilized :

1. Nazlikul, H: Neural therapy - Nobel Kitabevleri 2010 Istanbul
2. Nazlikul, H: Neuraltherapy - A Cure Is Possible - Destek publications 2019
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4. Nazlikul, H.: Thorakale Wirbelblockaden erfolgreich therapieren S34-38, 1, 2/2008 für Allgemeinärzte
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