Phenol Neurolysis Research Articles

Retraction: Comparison of the efficacy of genicular nerve phenol neurolysis and radiofrequency ablation for pain management in patients with knee osteoarthritis.

Retraction: Comparison of the efficacy of genicular nerve phenol neurolysis and radiofrequency ablation for pain management in patients with knee osteoarthritis.

Phenol neurolysis in people with spinal cord injury: a descriptive study.

Descriptive study. The study's main objective was to describe the common targets of phenol neurolysis and review the safety and efficacy of the dose used for this spasticity management procedure in people with spinal cord injury (SCI). An acute rehabilitation hospital. Data from people with SCI who underwent phenol neurolysis procedures for spasticity management between April 2017 and August 2018 were included in this study. We collected demographics and phenol neurolysis procedure-related information. A total of 66 people with SCI and spasticity underwent phenol neurolysis of 303 nerves over 102 encounters. During these encounters, 97% of procedures were performed using both electrical stimulation and ultrasound guidance. The median (IQR) total volume of 6% aqueous phenol used per encounter was 4.0 (2.0-6.0) ml with a median (IQR) of 1.5 (1.0-2.3) ml per nerve. The most frequent target was the obturator nerve (33%), followed by the pectoral nerves (23%). Immediate post-phenol neurolysis improvement or reduction in spasticity was reported for 92% of all documented encounters. There was no documentation of any post-procedure-related adverse events in this cohort during this specified time frame. Our findings suggest that phenol neurolysis can be safely used to manage spasticity in people with SCI under combined electrical stimulation and ultrasound guidance. Further research is required to assess the procedure's safety, efficacy, and cost-effectiveness on patient-reported outcomes compared to other spasticity interventions.

Ultrasound-guided preperitoneal phenol neurolysis for palliative pain.

Ultrasound-guided preperitoneal phenol neurolysis for palliative pain.

Early Use of Phenol Neurolysis Likely Reduces the Total Amount of Botulinum Toxin in Management of Post-Stroke Spasticity.

The main objective was to examine practice patterns of phenol neurolysis for post-stroke spasticity management in the early stage. We performed a chart review of patients who were admitted for inpatient rehabilitation within 6 months after first-ever stroke and received phenol neurolysis within 15 months post-stroke. Out of 2,367 stroke admissions from January 2014 and December 2018, 68 patients met the criteria. 52.9% of these patients received phenol neurolysis within 12 weeks, i.e., early stage. The earliest phenol neurolysis procedure was at 19 days after stroke. On average, patients received first phenol injections at 16.3 weeks after stroke with an average dose of 7.3 ml. Most commonly injected nerves were tibial nerve motor branches (41/68), sciatic nerve motor branches (37/68), lateral pectoral nerve (16/68), medial pectoral nerve (15/68), obturator nerve (15/68) and musculocutaneous nerve (15/68). Among 68 patients, 24 received phenol only; 17 received phenol neurolysis first followed by botulinum toxin (BoNT) injections; 19 received BoNT injections first followed by phenol neurolysis; 8 received both phenol and BoNT injections at the same time. The interval from stroke to first procedure was similar between the Phenol-First group (13.3 weeks) and the BoNT-First group (12.6 weeks). The total amount of BoNT was significantly lower in the Phenol-First group (361.3 units) than in the BoNT-First group (515.8 units) (p = 0.005). The total amount of phenol was not statistically different between the Phenol-First group (5.9 ml) and the BoNT-First group (8.3 ml). The interval between the first procedure and its subsequent procedure was not statistically different between the Phenol-First group (18.3 weeks) and the BoNT-First group (10.7 weeks). These long intervals suggest that the subsequent injection (type and dose) was not planned during the first procedure. The general patterns of target areas were similar between BoNT injections and phenol neurolysis, except that phenol neurolysis rarely targeted the upper extremity distal muscles. No side effects after phenol or BoNT injections in the early stage after stroke were observed in the chart review. In summary, phenol neurolysis was started as early as 19 days after stroke. On average, patients received first phenol about 4 months after stroke with an average of 7.3 ml of phenol. Early use of phenol neurolysis likely decreases the total amount of BoNT for management of post-stroke spasticity without increased side effects.

The Time Course of Onset and Peak Effects of Phenol Neurolysis.

The aim of this study was to explore the time course of onset and peak effects of phenol neurolysis. This is a retrospective chart review. Eleven patients with elbow flexor spasticity after brain injury were enrolled. The resting angle of the elbow joint was measured before and after the injection and up to 6 wks of follow-up. Phenol injection was performed to 13 musculocutaneous nerves under ultrasound and electrical stimulation guidance. The resting elbow angles were 84.4° ± 25.8° (before injection), 116.6° ± 20.9° (immediately after injection), 121.2° ± 21.4° (2 hrs after injection), 127.2° ± 19.7° (24 hrs after injection), 145.4° ± 11.8° (7 days after injection), 145.5° ± 10.4° (14 days after injection), and 150.3° ± 12.2° (6 wks after injection; N = 7). The mean resting angle was statistically different among the time points from preinjection to 14 days after (F2.625, 31.505 = 36.805, P < 0.01). Post hoc tests revealed that significant improvements existed immediately after and 7 days after the injection (P < 0.01 for both). The effects seemed to reach its peak in 7 days. The effect sizes immediately and 7 days after the injection were 1.37 and 3.04, respectively. The immediate effect accounted for approximately 60% of the maximal effect. Phenol neurolysis has an immediate effect on spasticity reduction and reaches its peak effect around 1 wk after injection.

Superior Cluneal Neuralgia from Iliocostal Impingement Treated with Phenol Neurolysis: A Case Report

Background: Superior cluneal neuralgia (SCN) is an increasingly recognized yet still frequently overlooked cause of chronic lumbosacral and buttock pain. While historically attributed generally to iatrogenic iliac crest injury (bone marrow biopsy or bone graft harvest), more recently it is recognized as occurring in the absence of any trauma, with idiopathic entrapment resulting in compression neuropathy. Iliocostal impingement syndrome (IIS) is an even less commonly considered condition whereby the lower costal margin repetitively contacts and irritates the iliac crest, primarily occurring unilaterally and owing to severe scoliosis, but also in the context of severe vertebral column height loss. Case Report: We report here a case of an elderly woman with a 3-inch reported height loss over the decades who had suffered with chronic and intractable right lumbosacral and gluteal pain, and whom, on the basis of physical examination, we diagnosed presumptively with both SCN and with IIS as the underlying pathophysiologic mechanism. After undergoing successful diagnostic fluoroscopically guided superior cluneal nerve block, she was offered phenol denervation and enjoyed 9 months of reported 90% improvement in her symptoms, with gradual return to baseline over the next couple months. She has subsequently undergone repeat phenol denervation twice, with similarly good results. We believe this to be the first documented application of phenol neurolytic technique to SCN, and in the case of iliocostal impingement we argue that surgical release/resection or even peripheral nerve stimulation may not be effective owing to underlying compression/irritation diathesis from the inevitable pressure of the costal margin upon the iliac crest. Conclusion: In this case report, we also briefly summarize the current literature on SCN and compare phenol neurolysis to other therapeutic modalities. Key words: Superior cluneal nerves, neuralgia, iliocostal impingement, phenol, denervation

Radiofrequency ablation and phenol neurolysis in a case of glossopharyngeal neuralgia due to a rare aetiology.

Radiofrequency ablation and phenol neurolysis in a case of glossopharyngeal neuralgia due to a rare aetiology.

Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity.

When managing patients with focal spasticity, phenol neurolysis is often avoided largely because of its presumed poor adverse effect profile. It is suggested that dysesthesias may be more common with phenol neurolysis of the mixed sensorimotor nerves (eg, radial, median, and ulnar nerves) compared to neurolysis of pure motor nerves. However, these risks may be mitigated with precise localization of pure motor branches by ultrasound and electrical stimulation (EStim). To explore practice patterns of phenol neurolysis to distal upper extremity mixed sensorimotor nerves with ultrasound and EStim guidance. A retrospective analysis of all neurolysis procedure records at a single institution from January 2013 to February 2018. Demographic and clinical variables including primary neurological diagnosis, concurrent spasticity treatments, nerves injected, phenol dosage and adverse events were abstracted from the electronic medical records. 57 patients who received phenol neurolysis with ultrasound and EStim guidance for spasticity management to radial, median, or ulnar nerves. Reported adverse effects. A total of 57 patients who collectively received neurolysis to 139 nerves across 102 encounters, met inclusion criteria. Most prevalent diagnoses included traumatic brain injury (N = 27, 47.4%) and stroke (N = 18, 31.6%), with a smaller subset having spinal cord injury (N = 10, 17.5%). Most patients received concomitant chemodenervation with botulinum toxin (N = 44, 77.2%). The average phenol dosage per nerve was 1.8 mL, with a range of 0.5-9.0 mL. Reported adverse effects included three cases of prolonged pain, but no dysesthesias were reported during the follow-up period (>40 days). Phenol neurolysis with ultrasound and EStim guidance was successfully and safely used to manage focal spasticity in the distal upper extremity. III.

Phenol Neurolysis of Genicular Nerves for Chronic Knee Pain

Phenol Neurolysis of Genicular Nerves for Chronic Knee Pain

O fenol como agente neurolítico no tratamento da espasticidade focal e multifocal

A síndrome piramidal ocorre nas lesões do sistema nervoso central que afetam as vias corticoespinhais e são definidas pela tríade de fraqueza muscular, aumento dos reflexos miotáticos e espasticidade, que é definida pelo aumento involuntário da resistência ao movimento passivo cuja intensidade varia com a velocidade do movimento. Quando a espasticidade interfere na funcionalidade do paciente, dificultando o movimento ativo, causando dor ou dificultando a prestação de cuidados por terceiros, há necessidade de iniciar seu tratamento. Para o tratamento da espasticidade generalizada ou de grandes porções do corpo, a intervenção medicamentosa ocorre por via oral ou intratecal, conforme os recursos disponíveis, mas efeitos colaterais de intensidade variável e indesejáveis podem ocorrer, especialmente o comprometimento da atenção ou da consciência, que prejudicam o processo de reabilitação. O tratamento focal da espasticidade utiliza a toxina botulínica ou os bloqueios nervosos com fenol ou álcool. Este artigo revisa a literatura sobre as técnicas mais adequadas para realizar a neurólise com fenol. Os bloqueios neuromusculares com fenol são um tratamento efetivo, de ação imediata, baixo custo, duração prolongada e de poucos efeitos adversos quando são respeitados os cuidados regulares de aplicação.

Treatment of chronic osteoarthritic hip pain with phenol neurolysis of the obturator nerve Quadfen 1

The conservative treatment of osteoarthritis (OA) of the hip is essentially symptomatic, seeking to relieve pain and optimize function. Despite presenting great clinical effect, hip arthroplasty may have restrictions, and in these situations, the neurolytic blockade of the anterior branch of the obturator nerve can be a therapeutic alternative, since it stops the afferent pain from the hip joint. Objective: To describe the results of treating patients with severe OA of the hip by applying phenol to the obturator nerve. Method: Twelve consecutive patients with OA of the hip, refractory to conservative treatment, were recruited to have the obturator nerve localized through electrostimulation and blocked with phenol. They were evaluated in terms of pain intensity via the visual analogue scale (VAS), pressure dolorimetry in the medial and lateral gluteus medius, gluteus minimus, and piriformis, and quality of life by the Harris Hip Score (HHS) at baseline (BL) after 1 (M1), 2 (M2), and 6 months (M6). Results: The patients were between 30 and 72 years old with an avarege of 47.5 ± 1.7 years old, 5 of them were women. Three patients were excluded for not being able to come for follow up evaluations. VAS values vaieded from 8.2 ±.0.9 at BL to 6.6 ± 1.7 at M1, 6.5 ± 1.7 at M2, and 7.3 ± 1 in M6 (p=0.0094). As to the HHS, the values were BL:33.27 ± 2.9; M1:39.2 ± 6.4; M2:40.2 ± 8.1, and M6: 38.8 ± 9.7 in the final evaluation (p=0,040). For dolorimetry, non significant variation was BL: 11±5.7, M1: 7.9±2.2; M2: 10.9±5.6; M6: 8.1 ± 1.6 (p 0.69). Conclusion: The application of phenol to the anterior branch of the obturator nerve can be an alternative in the treatment of severe OA of the hip in patients with restrictions to Total Hip Replacement (THR), since it reduces pain and improves quality of life.

Comparing Electrical Stimulation With and Without Ultrasound Guidance for Phenol Neurolysis to the Musculocutaneous Nerve

BackgroundUltrasound guidance is increasingly being used for neurolytic procedures that have traditionally been done with electrical stimulation (e-stim) guidance alone. Ultrasound visualization with e-stim−guided neurolysis can potentially allow adjustments in injection protocols that will reduce the volume of neurolytic agent needed to achieve clinical improvement. ObjectiveThis study compared e-stim only to e-stim with ultrasound guidance in phenol neurolysis of the musculocutaneous nerve (MCN) for elbow flexor spasticity. We also evaluated the ultrasound appearance of the MCN in this population. DesignRetrospective review. SettingUniversity hospital outpatient clinic. ParticipantsAdults (N = 167) receiving phenol neurolysis to the MCN for treatment of elbow flexor spasticity between 1997 and 2014 and adult control subjects. MethodsFor each phenol injection of the MCN, the method of guidance, volume of phenol injected, technical success, improved range of motion at the elbow postinjection, adverse effects, reason for termination of injections, and details of concomitant botulinum toxin injection were recorded. The ultrasound appearance of the MCN, including nerve cross-sectional area and shape, were recorded and compared between groups. Main Outcome MeasuresThe volume of phenol injected and MCN cross-sectional area and shape as demonstrated by ultrasound. ResultsThe addition of ultrasound to e-stim−guided phenol neurolysis was associated with lower doses of phenol when compared to e-stim guidance alone (2.31 mL versus 3.69 mL, P < .001). With subsequent injections, the dose of phenol increased with e-stim guidance (P < .001), but not with e-stim and ultrasound guidance (P = .95). Both methods of guidance had high technical success, improved ROM at elbow postinjection, and low rates of adverse events. In comparing the ultrasound appearance of the MCN in patients with spasticity to that of normal controls, there was no difference in the cross-sectional area of the nerve, but there was more variability in shape. ConclusionsCombined e-stim and ultrasound guidance during phenol neurolysis to the MCN allows a smaller volume of phenol to be used for equal effect, both at initial and repeat injection. The MCN shape was more variable in individuals with spasticity; this should be recognized so as to successfully locate the nerve to perform neurolysis. Level of EvidenceIV

Practice patterns for spasticity management with phenol neurolysis.

To present practice patterns for phenol neurolysis procedures conducted for spasticity management. A retrospective review of 185 persons with spasticity who underwent phenol neurolysis procedures (n = 293) at an academic rehabilitation hospital and clinic. Patient demographics, concomitant spasticity treatments, and procedure relevant information were collected. The cohort included 71.9% males and 61.6% inpatient procedures. Neurological diagnoses included stroke (41.0%), traumatic brain injury (28.6%) and spinal cord injury (24.3%). Musculoskeletal diagnoses included spastic hemiplegia or paresis (51.3%), tetraplegia (38.4) and paraplegia (9.2%). At the time of phenol neurolysis, most patients (77.5%) received concomitant pharmacological treatments for spasticity. Injection guidance modalities included electrical stimulation and ultrasound (69.3%) or ultrasound only (27.3%). A mean of 3.48 ml of phenol were injected per nerve and 10.95 ml of phenol were used per procedure. Most commonly injected nerves included the obturator nerve (35.8%) and sciatic branches to the hamstrings and adductor magnus (27.0%). Post-phenol neurolysis assessment was recorded in 54.9% of encounters, in which 84.5% reported subjective benefit. Post-procedure adverse events included pain (4.0%), swelling and inflammation (2.7%), dysaesthesia (0.7%) and hypotension (0.7%). Phenol neurolysis is currently used to reduce spasticity for various functional goals, including preventing contractures and improving gait. Depending on the pattern ofspasticity displayed, numerous peripheral nerves in the upper and lower extremities can be targeted for treatment with phenol neurolysis. Further research into its role in spasticity management, including studies exploring its cost-effectiveness and pharmacological and side-effects compared with other treatment options are needed.

Poster 218 A Multi-Year Experience with Phenol Neurolysis for Spasticity Management: Practice Pattern and Clinical Outcomes.

Poster 218 A Multi-Year Experience with Phenol Neurolysis for Spasticity Management: Practice Pattern and Clinical Outcomes.

Intercostal Administration of Liposomal Bupivacaine as a Prognostic Nerve Block Prior to Phenol Neurolysis for Intractable Chest Wall Pain

ABSTRACTInadequate pain relief from systemic medications is common in patients with advanced malignancy. Chest wall pain secondary to tumor involvement of chest wall structures can be challenging to manage with systemic medications, and occasionally patients benefit from interventional procedures such as intercostal nerve blocks and neurolysis. In this report, the authors describe the case of a 58-year-old woman with advanced non-small cell lung cancer with tumor invasion into the third thoracic rib. After reaching maximum tolerated doses of transdermal fentanyl, oral hydromorphone, and oral ketamine, the patient elected for intercostal nerve blockade and neurolysis. Prognostic nerve blockade was performed using liposomal bupivacaine administered via intercostal approach. This formulation of bupivacaine provided an excellent prognostic blockade, which lasted for approximately 96 hours. This extended period of time allowed the patient to fully evaluate the prognostic blockade, prior to proceeding with neurolysis with phenol. This case suggests that liposomal bupivacaine may be a valuable adjunctive agent for prognostic blockade prior to neurolysis for cancer pain.

Transversus Abdominis Plane Neurolysis with Phenol in Abdominal Wall Cancer Pain Palliation

Pain is commonly perceived by patients during cancer and its treatment. Although most patients respond to conservative management implemented according to the World Health Organization guidelines, a subset of patients with advanced disease develop intractable pain that may require additional interventions such as regional blocks and intrathecal therapy. Patients with terminal abdominal or pelvic cancer who have high tumor burdens are often offered a diagnostic visceral nerve block followed by neurolysis for pain palliation. Conventional visceral blocks usually require fluoroscopic guidance for correct needle placement in the vicinity of the neuroaxis or abdominal cavity. These techniques carry risks of injury to vessels, bowels, and nerves. Transversus abdominis plane (TAP) block is a technique that is easy to perform (particularly when ultrasonographic guidance is used), has a good safety record, and effectively reduces pain levels and opioid requirements after abdominal and gynecological surgery. Although numerous studies have demonstrated the effectiveness of TAP blocks in acute pain management, the role of TAP block in chronic pain management is very limited. We believe that chemical neurolysis with phenol can prolong the effects of analgesia in patients with terminal cancer. We describe a case of terminal abdominal sarcoma with intractable pain that responded well to a TAP block followed by TAP neurolysis. The patient tolerated the procedure well and demonstrated sustained analgesia for 45 days before dying of the disease. We also demonstrated that TAP block significantly reduces the total opioid requirement as demonstrated by the morphine equivalent daily dose score after the neurolytic procedure. This result supports our belief that TAP block with TAP neurolysis is an effective and inexpensive modality that can be used to palliate intractable abdominal wall pain in patients with terminal abdominal cancer. Key words: Cancer pain management, phenol neurolysis, chemical neurolysis, transversus abdominis plane block, cancer pain palliation, intractable abdominal pain, ultrasound guided

Acute developing transient paraparesis after celiac plexus block: MRI findings

Purpose An endometrium cancer with liver metastasis, developing continuous and severe abdominal pain with vomiting and constipation, following phenol celiac plexus neurolysis, is described to find out if MRI can explain the reason of neurologic deficit. Materials and methods A 81-year-old woman with metastatic endometrium cancer underwent celiac plexus phenol neurolysis for management of severe pain at right hypochondriacal region. In spite of apparently adequate needle position, she developed transient paraplegia consistent with anterior spinal artery syndrome. At 48 h after celiac plexus block MRI was performed. Results In this patient, paraplegia suddenly ensued after instillation of the phenol solution, and postprocedure spinal MRI showed increased signal in the thoracic spinal cord consistent with edema. The patient was discharged 25 days after the block with clinically insignificant neurological deficit. Conclusion We present a case of a patient who had paraparesis after the performance of celiac plexus block (CPB). We propose that the mechanism for this rare but devastating complication is the neurotoxicity of phenol on spinal cord which may result from spasmotic effect of phenol on spinal feeding arteries. In such cases MRI, especially the short tau inversion recovery (STIR) sequence should be performed to see the acute changes in spinal cord in patients with acute developing neurologic deficit following CPB.

Eficacia del bloqueo del ganglio impar en dolor pélvico y perineal de etiología ginecológica rebelde a tratamiento médico-quirúrgico

Visceral pain transmitted by fibers of the sympathetic nervous system in the perineal and pelvic area, whether of benign or malignant etiology, can be effectively treated with neurolysis of the ganglion of Walther, also known as the ganglion impar or sacrococcygeus ganglion. Other possible indications for this technique are shooting anal pain and enteritis. This blockade can rarely eliminate somatic pain or neuropathic features. After this technique has been performed, the required dose of opioid and non-opioid analgesic agents is usually substantially reduced, leading to relief of adverse effects and maximizing analgesic action. The performance of this percutaneous technique can be considered to be of low complexity and with minimal side effects. We describe five cases of pelvic, perineal and coccygeal pain of different etiologies and poor response to conventional drug treatment, as well as the response and clinical course of these patients after completion of ganglion impar blockade with radiofrequency, local anesthetics and phenol neurolysis.

16. Complex Regional Pain Syndrome

AbstractComplex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy is a pain syndrome with an unclear pathophysiology and unpredictable clinical course. The disease is often therapy resistant, the natural course not always favorable. The diagnosis of CRPS is based on signs and symptoms derived from medical history and physical examination. Pharmacological pain management and physical rehabilitation of limb function are the main pillars of therapy and should be started as early as possible. If, however, there is no improvement of limb function and persistent severe pain, interventional pain management techniques may be considered.Intravenous regional blocks with guanethidine did not prove superior to placebo but frequent side effects occurred.Therefore this technique receives a negative recommendation (2 A–). Sympathetic block is the interventional treatment of first choice and has a 2 B+ rating. Ganglion stellatum (stellate ganglion) block with repeated local anesthetic injections or by radiofrequency denervation after positive diagnostic block is documented in prospective and retrospective trials in patients suffering from upper limb CRPS. Lumbar sympathetic blocks can be performed with repeated local anesthetic injections. For a more prolonged lumbar sympathetic block radiofrequency treatment is preferred over phenol neurolysis because effects are comparable whereas the risk for side effects is lower (2 B+). For patients suffering from CRPS refractory to conventional treatment and sympathetic blocks, plexus brachialis block or continuous epidural infusion analgesia coupled with exercise therapy may be tried (2 C+). Spinal cord stimulation is recommended if other treatments fail to improve pain and dysfunction (2 B+). Alternatively peripheral nerve stimulation can be considered, preferentially in study conditions (2 C+).

The effects of phenol neurolysis of the obturator nerve on the distribution of buttock-seat interface pressure in spinal cord injury patients with hip adductor spasticity

Hip adductor spasticity may adversely effect shear-force and pressure distribution on the buttocks, where ulcerations most frequently appear in patients with spinal cord injury (SCI). Phenol neurolysis of the obturator nerve (ON) is commonly used to manage hip adductor spasticity. This study aimed to determine the effects on the distribution of buttock-seat interface pressure (BSIP) in a group of SCI patients with adductor spasticity that underwent ON blockade with phenol. We reviewed the records of SCI patients that were admitted to our clinic between January 2009 and December 2009. BSIP values (obtained with an X-sensor 48) and hip adductor spasticity levels of SCI patients with hip adductor spasticity that underwent ON blockade with phenol were collected. BSIP distributions of the patients were divided into two portions: first one is the BSIP distribution at the pressure ≤37 mm Hg, and the second one is at the pressure >37 mm Hg. The study included 20 SCI patients (19 males and 1 female), with a mean age of 42.85±13.24 years. Although the percentage of BSIP distribution at ≤37 mm Hg range increased significantly (P<0.001), after ON neurolysis, BSIP distribution at >37 mm Hg range decreased significantly (P<0.001). In addition, mean hip adductor spasticity decreased significantly after ON neurolysis (P<0.001). Phenol neurolysis of the ON is a promising treatment for the management of hip adductor spasticity in SCI patients and also has positive effects on BSIP, which has a crucial function in the development of pressure ulcers.