Phenol Block Research Articles

Refractory pain in the original anus after rectal cancer surgery improved by repeated subarachnoid phenol block: a case report

Refractory pain in the original anus after rectal cancer surgery improved by repeated subarachnoid phenol block: a case report

Obturator nerve block with aqueous phenol reduces hip adductor spasticity

Spasticity is a cardinal symptom of the upper motor neuron syndrome. It affects the different individuals differently. Hip adductor spasticity can be very painful and result in postural abnormalities that interfere with walking, transferring and hygiene. Phenol block of the obturator nerve results in neurolysis reducing the hip adductor spasticity. Patients with known spasticity in the lower limbs who had been assessed suitable for phenol nerve block had Modified Ashworth Scale (MAS) and intercondylar distances recorded before the phenol nerve block, the at 6 weeks and 6 month's post phenol nerve block. Non-parametric Friedman test of differences among repeated measures was conducted from data at 0, 6 and 24 weeks. Fifty-two obturator nerves were blocked using 5% phenol. The procedure was bilateral in 38 patients and unilateral in 14 patients. There were 34 females and 18 males. Minimum age was 18 years and maximum age was 78 years with a mean age of 50.6 years. Majority of patients (28.8%) had a diagnosis of multiple sclerosis. There was statistically significant difference between the pre-injections MAS and intercondylar distance at 6 weeks and 6 months. Spasticity of the lower limb, especially adductor muscle spasm, is a major source of long-standing disability and pain in neurological patients. It is a cost-effective procedure that leads to improved personal hygiene. It is operator dependent and needs skills and training to inject phenol without complications.

How to Design the Tailor-made Treatment of Spasticity：Applying Different Dilutions of Botulinum Toxin and/or Using Combined Phenol Block

How to Design the Tailor-made Treatment of Spasticity：Applying Different Dilutions of Botulinum Toxin and/or Using Combined Phenol Block

Phenol Versus Botulinum Toxin A Injection in Ambulatory Cerebral Palsy Spastic Diplegia: A Comparative Study.

The aim of this study is to compare the treatment effectiveness of botulinum toxin type A (BTX-A) and phenol blocks in the management of lower limb spasticity and to measure improvement in gross motor functional outcome in children with cerebral palsy (CP). This is a hospital-based prospective, noncontrolled randomized study that took place in a tertiary care center. A total of 61 ambulatory children with CP spastic diplegia, aged from 4 to 10 years, were randomly divided into two groups and included in this study. Twenty-eight children with CP received BTX-A injections and 33 received phenol motor point blocks. The measures performed were as follows: outcome assessment spasticity by the Modified Ashworth scale (MAS), active range of motion (AROM) of lower limb joint by goniometer, and functional improvement by Gross Motor Function Measures (GMFM). Postinjection follow-up done at 2, 6, 12, 24, and 48 weeks. Significant improvement in reduction of spasticity, increased AROM of all joints of lower limbs, and improvement in functional outcome were observed in CP with spastic diplegia after BTX-A injections as compared with the phenol motor point block group. There was no significant side effect after BTX-A injections as compared with phenol injections. BTX-A injections showed superior treatment effects in the reduction of spasticity and improvement in AROM and functional outcome measures with spastic diplegia as compared with phenol blocks. BTX-A injections also revealed fewer clinical side effects and were well tolerated by children with CP.

Ocular myasthenia gravis in a person with tetraplegia presenting challenges in diagnosis and management

We report the first case of ocular myasthenia gravis (OMG) in a patient with complete tetraplegia, highlighting diagnostic and management challenges. Spinal multidisciplinary rural clinic and specialised inpatient Spinal Cord Injury Unit, NSW, Australia. A 61-year-old man with established C5 AIS A tetraplegia, presented with sudden onset of diplopia and bilateral ptosis, later diagnosed as OMG, in context of other complex co-morbidities, including a cervical cord syrinx, obstructive sleep apnoea and labile blood pressure. Clinical findings were consistent with fluctuating bilateral partial third and sixth nerve palsies. Acetylcholine receptor antibodies were negative, but electromyography demonstrated muscle fatigue. The ocular signs responded well to pyridostigmine. Medications taken before diagnosis, including solifenacin for neurogenic bladder overactivity, were ceased to avoid attenuating the anti-cholinesterase effect. However, the unopposed anti-cholinesterase activity led to frequent and painful abdominal spasms, associated with uncontrolled detrusor hyperreflexia and worsening autonomic dysreflexia (AD). A trans-vesical phenol block to treat this provided only short-lasting benefit. Pyridostigmine was ceased to avoid provoking his abdominal spasms and his regular medications were recommenced. It was decided that the most appropriate treatment for his distressing diplopia was an eye patch. After discharge home, he continued to experience problems with recurrent urinary tract infections, abdominal spasms, episodic postural hypotension and AD. After 5 months, the patient died from an acute myocardial infarction. This case report contributes new knowledge about the rare presentation of OMG in a person with chronic tetraplegia.

Ultrasound Guided Phenol Block of the Obturator Nerve for Severe Adductor Spasticity: A Pilot Study

Objective: To assess the efficacy of phenol block of the obturator nerve in treating severe adductor spasticity. Design: A prospective pilot study. Setting: Outpatient rehabilitation clinics. Participants: We recruited 5 participants with severe adductor spasticity. Four were persons with multiple sclerosis and one was a person with adult cerebral palsy. All participants were women and had an average age of 60.4 years; four participants had bilateral severe adductor spasticity and one had unilateral severe adductor spasticity. Interventions: A total of 9 phenol blocks of the obturator nerve were performed. Five were performed with ultrasound guidance, followed by localization of the obturator nerve by peripheral nerve stimulator. Four were performed using anatomic landmark and peripheral nerve stimulator for localization. Outcome Measures: The primary outcome measure was the Modified Ashworth Scale score of the hip adductor at 1 month after the obturator nerve block. The secondary outcomes measures include Modified Ashworth Scale (MAS) score of the hip adductors at 6 months, distance between the right and left medial femur condyles in supine with hip extended to neutral, Disability Assessment Scale (DAS) score, Goal Attainment Scale (GAS) score, Spasticity Numeric Rating Scale score and Subjects’ and Physician Global Impression of Changes scores. Results: There was statistically significant decrease in the MAS score at 1-month compared to baseline (2.43 vs. 4; P=0.001). There was no statistically significant difference in the secondary outcomes. There were no reported adverse effects of procedure. Conclusion: This study suggests that phenol block of the obturator nerve is effective in treating severe adductor spasticity. We recommend a larger study with more participants and longer follow up period to allow further assessment of the efficacy of the phenol block of the obturator nerve in treating severe adductor spasticity.

Optimal Effect of Phenol Block in the Sciatic Nerve of Rats: Standardization of Minimized Dosage and Duration of Application.

The phenol nerve block has been widely used in clinical practice for spasticity reduction, but the correlation between the dosage of phenol and its effectiveness has seldom been discussed. The objective was to determine the optimal duration of phenol in contact with the nervous tissue and to investigate the dose-response relationship of 5% aqueous phenol solution by percutaneous nerve block in rats. Group I (n = 8) received sciatic nerve block by bathing the nerves in phenol solution, and group II (n = 40) by injecting phenol percutaneously. Group IIa to IId received different volumes (0.80, 0.16, 0.08 and 0.04 ml) and group IIe received normal saline. Compound muscle action potential (CMAP) was measured pre-injection and at 90 and 270 sec after injection and after surgical exposure of the nerves. The duration of CMAP reduced by 10%, 25%, 50%, 75% and 100% after phenol injection was also recorded. The mean latency for the evoked response to subside in direct phenol application (group I) and percutaneous nerve block (group IIa) were 73.5 ± 5.9 and 62.4 ± 7.6 sec, respectively. There was no statistical difference for the time periods in the blocking effect elicited by phenol solution between these two methods. Ninety sec was set as the optimal duration for phenol to produce complete conduction blockage. Higher volume of phenol produced more significant blocking effect at 90 and 270 sec after injection. Percutaneous injection with 0.16 ml of phenol solution had the same blocking effect as 0.8 ml. The continuous injection model for percutaneous phenol block indeed used significantly more phenol than actually needed. Clinically, the progressive injection model can be used to minimize injection volume.

Evaluation of the analgesic effect of subarachnoid phenol block in cancer pain

Evaluation of the analgesic effect of subarachnoid phenol block in cancer pain

Phenol block for upper limb spasticity

Phenol block for upper limb spasticity

The effect of motor point blocking on spasticity in children with cerebral palsy

Objective To compare the advantages and disadvantages of botulinum toxin A (BTX-A) and phenol block in the treatment of spasticity in children with cerebral palsy. Methods Four hundred and twenty children with spastic cerebral palsy were divided into an experimental group (375 cases) and a control group (45 cases).The children were aged from 1 to 22 years ( average age 6 years).The children in the experimental group were treated with BTX-A block at a dosage of 55 to 350 IU (average 130.5 IU).The children in the control group were treated with a 5％ phenol solution block at a dosage of 0.5 to 4.6 ml ( average 2.2 ml).Children of both groups were given systematic functional rehabilitation training. All the children were evaluated with a physician rating scale (PRS) and the modified Ashworth scale (MAS) before and after the blocking.Effectiveness rates,effectiveness durations and side effects rates were calculated. Results Before treatment there was no significant difference in terms of motor disorder or spasticity between the 2 groups.After treatment,spasticity had been significantly reduced in both groups.The effectiveness rate was 98.4％ in the experimental group and 95.6％ in the control group,a difference which was not significant.The average effectiveness duration was ( 24.9 ± 5.76 ) weeks in the experimental group and ( 69.2 ± 13.76) weeks in the control group,significantly longer.The side effects rate was 5.33 ％ in the experimental group and 15.56％ in the control group,also a significant difference. Conclusion BTX-A could be more widely used because of its safety and credibility. Key words: Cerebral palsy; Spasticity; Nerve blocking; Botulinum toxin-A; Phenol blocking

Efficacy of occupational therapy and serial casting in lower limbs of cerebral palsy children administered with phenol nerve block

Abstract To see the efficacy of occupational therapy and serial casting over occupational therapy alone in case of sciatic nerve block in cerebral palsy children. In the study 18 spastic cerebral palsy children were treated with in-traneural phenol block (open technique) followed by occupational therapy to bring out functional change. All the 18 patients were administered with intraneural phenol block. In 9 patients serial casting combined with occupational therapy (experimental group) was given while in another group 9 patients were treated with occupational therapy alone (control group). The treatment session for each patient lasted for 6 weeks. To measure the outcome GMFM 66, pediatric balance test (PBT), active range of motion, passive range of motion, modified Ashworth scale were used as tool. There was significant reduction in spasticity of all the 18 patients (after administration of intraneural phenol nerve block) when compared with their pre-operative status. There was significant improvement of gross motor function (GMFM 66), active and dynamic balance (through PBT), and active range of movement of knee joint in experimental group. There was no significant difference between the groups in passive range of motion and reduction of spasticity. The study concludes that intraneural phenol block reduces spasticity in cerebral palsy children to a significant level thus improving the functional outcome in these children. Serial casting when combined with occupational therapy after phenol block gives much better and quicker improvement in gross motor function and motor milestone development.

Successful elimination of intractable anal pain associated with rectal cancer by combination of subarachnoid phenol block with sacral nerve root thermocoagulation

【目的】直腸がん術後の旧肛門部の疼痛に対し, くも膜下フェノールブロックと仙骨部神経根高周波熱凝固術が著効した症例を経験したので報告する.【症例】61歳, 男性. 直腸がん再発の旧肛門部の疼痛に対し, オピオイドなどの鎮痛薬が投与されていたが, 疼痛管理が困難な状態であった. これに対し, くも膜下フェノールブロックを施行することでオピオイドを中止できる程度に疼痛が軽減した. しかし, 数週間後, 第3仙髄神経の支配領域である旧肛門深部の疼痛が増悪してきたため, 仙骨部神経根高周波熱凝固術を施行したところ, 疼痛の消失が得られた.【結論】直腸がん術後の骨盤内再発における旧肛門部の疼痛は, くも膜下フェノールブロックのみでは疼痛管理に難渋することがあるが, 仙骨部神経根高周波熱凝固術を併用することで疼痛緩和を得られる可能性がある. Palliat Care Res 2010; 5(2): 314-316

Intrathecal phenol block for severe spinal spasticity

Intrathecal phenol block for severe spinal spasticity

Management of spasticity in children with cerebral palsy

Management of spasticity is a major challenge to the rehabilitation team. The initial management has centered on the elimination of externally exacerbating causes, physical therapy, splinting and casting. Medical management has centered on anti-spasticity medication use, but more recently focal treatment methods including phenol blocks and botulinum toxin have been utilized. There has been an increased use of intrathecal baclofen in the management of refractory tone. Dorsal rhizotomy has been advocated for a selective population of children with spasticity. There is no standardized approach to spasticity management and this paper will discuss the importance of evidence-based treatment of spasticity that is adapted for the individual child.

Subscapularis motor point block for spastic shoulders in patients with cervical cord injury

Case series. The objective was to study the effect of phenol blocks to the motor points of the subscapularis muscle in patients with cervical cord injury (CCI). Spinal cord injury units of a national hospital in Tokyo. The participants were seven patients with traumatic CCI, mean age 55.8 years (SD4.0), whose injury level were at the fifth cervical level and the American Spinal Injury Association (ASIA) impairment scale was A in 2, C in 1 and D in 4. They were at least 5 months post-acute injury, and complained of pain and limited range of motion (ROM) of their shoulder joint that were unresponsive to usual rehabilitative interventions and medications. Before and after the phenol block to the motor points of the subscapularis muscle, we compared passive and active ROM of the shoulder (flexion, abduction and external rotation), spasticity of the subscapularis as assessed with the modified Ashworth scale, pain as evaluated with a visual analog scale, and eating item of the Functional Independence Measure. There were significant improvements in passive ROM in flexion (23.7 degrees ), abduction (19.4 degrees ) and external rotation (16.8 degrees ; P<0.05). Visual analog scale for shoulder pain was reduced from 6.0 to 3.4 (P<0.05). The modified Ashworth scale for shoulder spasticity, however, did not significantly change. The eating Functional Independence Measure item score improved significantly (P<0.05). This study suggests that subscapularis motor point block for pain and limited ROM with spastic shoulder is a useful technique in patients with CCI.

Phenol block for spasticity management

Peripheral blocks with botulinum toxin (BoTN) and phenol are the treatment of first choice in the management of focal spasticity. This review will focus on phenol blocks, presenting some historical aspects, principles of action, main indications and the clinical applicability of this substance. The purpose of this review is to remind that, when its indications are respected, phenol has shown a good balance between efficacy and safety. Since it is an extremely low-cost drug, phenol should be considered as the ideal agent for large-scale use in resource-poor rehabilitation centres.

Phenol Blocks for Treatment of Focal Spasticity

North American Brain Injury Society's Sixth Annual Conference on Brain Injury: October 2–4, 2008, New Orleans, Louisiana: Abstract

Phenol block for cervical dystonia: effects and side effects

Takeuchi N, Chuma T, Mano Y. Phenol block for cervical dystonia: effects and side effects. Arch Phys Med Rehabil 2004;85:1117-20. Objective To report on the effectiveness and side effects of 2% phenol block in patients with cervical dystonia (CD). Design Case series. Setting A rehabilitation department at a university medical center in Japan. Participants Sixteen patients (11 men, 5 women; mean age ± standard deviation, 43.4±11.2y) with CD. The cause of the CD was unknown, and all cases were refractory to the oral medication and rehabilitation therapy. Intervention Two percent phenol blocks guided by electromyography. Main outcome measures A blind analysis by neurologists of the Tsui score before and after 2 weeks of treatment with phenol block. Side effects were evaluated by another neurologist and patient report. Results There was significant ( P=.0002) improvement in neck movement and position, based on a reduced Tsui score, after the phenol block. However, 4 patients had a complication of sensory disturbance of the transverse cutaneous nerve of the neck area. The sensory disturbances decreased gradually and disappeared within 3 months, whereas the effects of the phenol block continued. Conclusions Phenol block can reduce the impact of CD that is refractory to therapy.

Radiofrequency Thermocoagulation of Splanchnic Nerve in Patients with Upper Abdominal Pain

The splanchnic nerve block can be an alternative method for the pain control in the upper abdomen, when the celiac plexus block does not work. And the radiofrequency thermocoagulation has benefits over alcohol or phenol block because its effect is more localized and predictable. This report describe two patients with metastatic cancer pain in the abdominal cavity who successfully treated with the splanchnic nerve block by using radiofrequency thermocoagulation.

Poster 16: Use of open phenol blocks in the treatment of lower-extremity spasticity in an adult with severe traumatic brain injury: a case report

Setting: Free-standing acute rehabilitation facility. Patient: A 37-year-old man with severe traumatic brain injury. Case Description: Physical examination revealed spasticity of bilateral lower extremities (rated as a 4 on the Ashworth Scale) resulting in severe equinovarus deformities. This resulted in the patient’s inability to stand, transfer, and ambulate. Treatments with positioning, splinting, serial casting, dantrolene, transcutaneous phenol blocks, and botulinum toxin type A injections showed no improvements. Further investigation of spasticity management revealed another treatment option. Open phenol blocks to the bilateral tibial nerves at the popliteal fossa were performed. The patient tolerated the procedure well. Assessment/Results: 2 weeks after bilateral open phenol blocks, the patient’s ankle range of motion improved. He was able to maintain both feet in a neutral position and that led to an increased ability to aid in transfers and standing. With physical therapy and casting, the patient was able to ambulate using a walker. Discussion: Although open phenol blocks were once well-known procedures, they are no longer considered current treatment options. Conclusion: This case demonstrates the effectiveness of injecting phenol directly into the nerve to decrease spasticity. An open phenol block is an effective treatment of severe spasticity and should be considered.