Phenol Neurolysis Research Articles

Neurolytic phenol blockade of the obturator nerve for severe adductor spasticity

In this study, we present the 3-month follow-up results of a retrospective analysis of obturator nerve (ON) phenol neurolysis performed between 2000 and 2007 in patients with adductor spasticity. The study was performed by retrospective investigation of the clinical follow-up results of 80 ON phenol treatments in 62 patients. Neurolysis using 5-10 ml 6% phenol was applied with the guidance of fluoroscopy and a peripheral nerve stimulator. Pain, spasticity and hygiene were evaluated and the hip abduction range of motion (ROM) was measured at the end of the first week and in the first, second and third months following the intervention. The visual analogue scale scores decreased significantly in the first week, first month and the second month, but reached their initial values in the third month. A drastic increase in the ROM values was shown in hip abduction in the first week, first month and second month. An increase in the Ashworth Scale values was observed in the second and third months, but they did not reach their initial values. The hygiene score decreased drastically in the first week and the first and second months, but worsened in the third month. The success rate in nerve localization during ON neurolysis was 100%. ON phenol blockade with fluoroscopy and peripheral nerve stimulator guidance in patients with adductor spasticity led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene with an efficacy lasting for about 3 months.

Transforaminal 5% Phenol Neurolysis for the Treatment of Intractable Cancer Pain

This is the first case report of using a transforaminal approach for phenol administration. A 76-yr-old patient with a history of leiomyosarcoma and multiple metastatic lesions had unremitting pain in the right thoracic and lumbar regions and had prohibitive opioid-induced side effects. The patient underwent phenol neurolysis using a transforaminal approach in 2 stages at 3 levels (L3-4, L1-2, and T12-L1). The patient had complete resolution of pain, without any complications, and opioid treatment was nearly discontinued. Transforaminal phenol neurolysis is a reasonable treatment option for patients suffering from intractable pain for whom conventional therapies have proven ineffective.

Phenol neurolysis for relieving intermittent involuntary painful spasm in upper motor neuron syndromes: A pilot study

The aim of this study was to assess the efficacy of phenol neurolysis in relieving intermittent attacks of involuntary painful muscle spasm in patients with upper motor neurone syndromes. Case series. Nineteen patients with intermittent involuntary painful muscle spasm of one of the following muscles: extensor hallucis longus (n=13), psoas major (n=3), tensor fascia lata (n=1) or vastus lateralis (n=2). Phenol neurolysis was performed for the target muscles using a Teflon-coated stainless-steel injection needle (connected to a block stimulator). The change in frequency and severity of intermittent involuntary painful muscle spasm was assessed 1, 2, 8 and 24 weeks after neurolysis. The frequency and severity of intermittent involuntary painful muscle spasm decreased in all patients for 24 weeks following neurolysis. Analgesic drugs were not required for the intermittent involuntary painful muscle spasm and no serious side-effects were observed following neurolysis. Phenol neurolysis gave promising results in treating intermittent involuntary painful muscle spasm in patients with upper motor neurone syndromes.

Neurological and histopathological effects of epidural phenol neurolysis in the rabbit

Abstract Objectives: Epidural phenol neurolysis for severe cancer pain has been linked to complications such as paraplegia and urinary incontinence. Given the ease of administration of epidural injections, proof of the safety and efficacy of epidural phenol injection would increase the popularity of this procedure for cancer pain relief. This study was conducted to evaluate the analgesic effects and histopathological changes in the spinal nervous system of rabbits after epidural administration of phenol. Materials and methods: Under pentobarbital anesthesia, percutaneous epidural catheterization at the level of the L6–L7 lumbar interspace was conducted in 16 rabbits. After epidurography using 0.3 ml of iopamidol, 0.3 ml of 7% phenol in saline was injected through the catheter into the epidural space of 15 rabbits, and 0.3 ml saline was epidurally injected in one rabbit serving as control. Motor function and analgesia were investigated on days 1 and 14. On day 14, the spinal cords were resected and process...

Phenol Neurolysis for Severe Chronic Nonmalignant Pain: Is the Old also Obsolete?

Our purpose was to reassess the effectiveness of phenol 4% in aqueous solution for neurolysis in patients with severe chronic nonmalignant pain syndromes who did not achieve adequate pain control (visual analog scale [VAS] <or=3) with conventional pain treatment. Forty-two patients with severe nonmalignant pain persisting for 6 months or longer were followed for more than 6 months after phenol neurolysis in this prospective observational study. All patients had previously received narcotic drugs, with or without nonsteroidal anti-inflammatory agents or adjuvants, without adequate pain relief. An aqueous solution of phenol 4% was used for chemical neurolysis. A fluoroscopically guided technique was used for chemical lumbar sympathectomy, medial branch destruction, and sacroiliac injections. Anatomic-landmarks technique was used for intercostal neurolysis, greater occipital nerve destruction, genitofemoral neuroablation, and paracoccygeal infiltration. Good pain relief (VAS <or=3) was achieved in 35 patients after neurolysis with phenol, and the mean VAS decreased from 8.74 +/- 1.08 (range 7-10) before treatment to 1.93 +/- 2.41 after treatment (P<0.0001). The mean VAS for assessment of the quality of pain relief after phenol neurolysis was 8.4 +/- 2.39, ranging from 0 (no relief at all) to 10 (complete relief ). No major complications were seen. The use of phenol 4% in aqueous solution is an effective and safe technique for neurolysis. Because of the potential risk of flaccid paralysis, this technique should be used in selected cases, far removed from motor nerves and the spinal cord.

Cryoanalgesia in Interventional Pain Management

Cryoneuroablation, also known as cryoanalgesia or cryoneurolysis, is a specialized technique for providing long-term pain relief in interventional pain management settings. Modern cryoanalgesia traces its roots to Cooper et al who developed in 1961, a device that used liquid nitrogen in a hollow tube that was insulated at the tip and achieved a temperature of - 190 degrees C. Lloyd et al proposed that cryoanalgesia was superior to other methods of peripheral nerve destruction, including alcohol neurolysis, phenol neurolysis, or surgical lesions. The application of cold to tissues creates a conduction block, similar to the effect of local anesthetics. Long-term pain relief from nerve freezing occurs because ice crystals create vascular damage to the vasonervorum, which produces severe endoneural edema. Cryoanalgesia disrupts the nerve structure and creates wallerian degeneration, but leaves the myelin sheath and endoneurium intact. Clinical applications of cryoanalgesia extend from its use in craniofacial pain secondary to trigeminal neuralgia, posterior auricular neuralgia, and glossopharyngeal neuralgia; chest wall pain with multiple conditions including post-thoracotomy neuromas, persistent pain after rib fractures, and post herpetic neuralgia in thoracic distribution; abdominal and pelvic pain secondary to ilioinguinal, iliohypogastric, genitofemoral, subgastric neuralgia; pudendal neuralgia; low back pain and lower extremity pain secondary to lumbar facet joint pathology, pseudosciatica, pain involving intraspinous ligament or supragluteal nerve, sacroiliac joint pain, cluneal neuralgia, obturator neuritis, and various types of peripheral neuropathy; and upper extremity pain secondary to suprascapular neuritis and other conditions of peripheral neuritis. This review describes historical concepts, physics and equipment, various clinical aspects, along with technical features, indications and contraindications, with clinical description of multiple conditions amenable to cryoanalgesia in interventional pain management settings.

Spasticity management in the child with spastic quadriplegia.

In children with spastic quadriplegia, also described as 'whole body involvement', spasticity can interfere with motor function, contributes to the development of deformities and adversely impacts on care, positioning, and comfort. In this population, spasticity interventions address goals such as improving comfort, reducing pain, easing the burden of carers, slowing the progression of musculoskeletal deformities and perhaps improving function. Children with severe diplegia are distinguished from those with quadriplegia by their ability to ambulate, as well as by a greater emphasis being placed on functional motor goals even though similar treatment modalities are often employed to manage spasticity. The many treatment options currently available include, but are not limited to, botulinum toxin type A, phenol neurolysis, oral medications, intrathecal baclofen, selective dorsal rhizotomy, and orthopaedic surgery. The integration of these treatment modalities can help to optimize the overall care and function for a child with spastic quadriplegia or severe diplegia. However, the development of a management programme is complex and needs to take into account many factors, including age, weight and nutritional status, rate of progression of musculoskeletal deformities, developmental potential, comorbid conditions, current functional status and prognosis, and family and patient treatment goals. Children with marked spasticity are likely to benefit from a combination of interventions, rather than a single treatment modality. Because of these complexities, management should be planned and coordinated by a multidisciplinary team of medical and allied health professionals which recognizes the central role of the family in all decisions. Once the special characteristics of the child with spastic quadriplegia and the various treatment options are understood, outcomes can be maximized.