Phenol Block Research Articles

Percutaneous phenol block of the musculocutaneous nerve to control elbow flexor spasticity

Twenty-three extremities in 17 brain-injured adults were prospectively studied to evaluate the effectiveness of percutaneous phenol blocks of the musculocutaneous nerve in controlling spasticity of the biceps and brachialis muscles. Twenty-one (93%) of the extremities improved after the initial injection. The mean resting position decreased from 120 degrees of flexion to 69 degress. Elbow range of motion increased an average of 53 degrees. There were no complications. Two patients did not respond to the initial injection and required repeat nerve blocks. Concomitant phenol motor point block of the brachioradialis muscle further improved elbow motion. The mean duration of the block was 5 months. Follow-up averaged 21 months. This study indicates that percutaneous phenol injection of the musculocutaneous nerve provides reliable, temporary relief of spasticity in patients with potential for further neurologic improvement.

クモ膜下フェノールブロックによる脊髄損傷患者の尿路管理

Subarachnoid phenol block was applied to four traumatic spinal cord injury patients who had been suffering from urinary incontinence caused by detrusor hyperreflexia. Two were females with complete thoracic cord injury, the others were males with incomplete cervical cord injury. In all patients, detrusor hyperreflexia and urinary incontinence disappeared after 0.3-0.6 ml injection of 10% phenol glycerin. Vesicoureteral reflux observed in three ureters of two patients disappeared or improved. Two obtained sufficient bladder capacity for urine storage, while the others who had been treated by continuous urine drainage for a long time prior to the block could not obtain sufficient bladder compliance. The cause seemed to be organization of the bladder wall.

フェノールの末梢神経に及ぼす影響 ＨＲＰ法による経時的観察

Applying the horseradish perioxidase technique, we studied the effect of the phenol on the peripheral nerve in 39 rats. One side of the sciatic nerve was blocked by 5% or 10% phenol for ten minutes, and irrigated with saline. At intervals of 1, 2, 4, 8 weeks, the spinal cord was removed, and the serial transverse sections were cut at 50μm and stained with diaminobenzidine. The horseradish peroxidase was injected into bilateral tibialis anterior muscles before sacrifice. The number and soma area histogram of the labelled motor neuron were compared with the unblocked side.Following results were obtained: 1) The labelled motor neuron number that was mostly decreased in two weeks after the phenol block was increased in four weeks (p<0.01), 2) The histological study of the sciatic nerve supported the change of labelled motor neuron number, 3) There was a low correlation between the amplitudes of evoked nerve potential and the labelled motor neuron number, and 4) The selectivity of the damage by the phenol to the peripheral nerve was not clear from the some area histogram.

慢性四肢動脈閉塞症に対する交感神経節フェノール・ブロック

慢性四肢動脈閉塞症に対する交感神経節フェノール・ブロック

Management of the Spastic Upper Extremity in the Neurologically Impaired Adult

Spasticity that interferes with upper extremity function is common in adults following stroke, brain injury, or anoxia. During the period of neurologic recovery definitive surgical procedures are avoided. Techniques to temporarily reduce spasticity include the implantation of a MicroPort reservoir and catheter for repeated branchial plexus blocks and phenol nerve blocks, which provide longer lasting relief of noxious muscle tone. Percutaneous blocks of the musculocutaneous and recurrent median nerves and motor point blocks of the pectoralis major, the brachioradialis, and forearm flexor muscles are easily performed at bedside. The motor branch of the ulnar nerve can be injected surgically with phenol to diminish intrinsic spasticity. When neurologic recovery has plateaued, hand placement can be improved in many patients following proximal release of the brachioradialis muscle and lengthening of the biceps and branchialis tendons. Hand function is enhanced by fractional lengthening of spastic wrist and finger flexors. Intrinsic spasticity must be addressed at the same time by phenol block or intrinic release. When extensor function is lacking, a tenodesis of the wrist extensors is helpful. The thumb-in-palm deformity requires proximal release of the thenar muscles as well as lengthening of the flexor pollicis longus. Contracture releases in the nonfunctional arm improve hygiene and ease care.

Current Status of Functional Lower Extremity Surgery in Adult Spastic Patients

Ten percent of upper motor neuron spastic patients are candidates for functional surgery. If the main cause of the disability is abnormal muscle tone and not sensation, balance, cognition, or perceptual problems, good results from tendon lengthening or transfers are to be expected. The preoperative work-up should consist of examination, trial orthoses, nerve blocks, and most importantly dynamic electromyography. Releases or neurectomies are generally done in nonfunctional patients. Phenol blocks are a temporizing procedure during the phase of neurologic recovery. The patients all tolerated the anesthesia well, and the surgical risks are the same as in other lower extremity procedures.

Percutaneous phenol blocks of the pectoralis major muscle to treat spastic deformities

Percutaneous phenol blocks of the pectoralis major muscle to treat spastic deformities

Phenol block of the tibial nerve for spasticity: A long-term follow-up study

Ninety-two tibial nerve blocks with phenol were performed in 59 patients for treatment of severe spasticity of the foot. The Achilles tendon reflex was abolished, ankle clonus was eliminated and resistance to passive stretch was reduced substantially following the procedure in all patients. Significant functional gains were observed as a result of decrease in spasticity with long-term follow-up averaging 28.7 months (range 14-60). The simplicity of the procedure, the functional results observed with long-lasting effects, and the lack of serious complications, would suggest the more widespread use of this procedure in the treatment of the spastic foot.

Management of intrinsic spasticity in the hand with phenol injection or neurectomy of the motor branch of the ulnar nerve

Thirty-nine adults with acquired spastic disorders who had 21 phenol injections and 21 neurectomies of the motor branch of the ulnar nerve in Guyon's canal for control of intrinsic spasticity in the hand were reviewed. Follow-up averaged 25.8 months for the patients with phenol blocks and 24.3 months for those who had a neurectomy. Intrinsic spasticity was relieved in all hands postoperatively. After the phenol block, which is a temporizing procedure, 13 hands had return of spasticity in 6 months. Eight hands had little or no return of spasticity and required no further treatment. Neurectomy was performed in predominantly nonfunctional hands with severe hygiene problems and with no potential for further neurologic recovery. Hand function was improved in six hands after phenol block and in one hand after neurectomy. Hygiene was improved in all hands after phenol block and in all except one hand after neurectomy. Two wound infections and one wound dehiscence occurred.

Percutaneous Phenol Block of the Upper Thoracic Sympathetic Chain with Computed Tomography Guidance

Twenty-one percutaneous neurolyses of the upper thoracic sympathetic chain were performed in 12 patients with CT guidance by a single injection of 1 to 3 ml of phenol at the level of Th3. Results were assessed after a follow-up period varying from 4 to 33 months. Three patients with hyperhidrosis had immediate and complete disappearance of symptoms, but only one patient remained dry. In 7/14 procedures done for Raynaud's disease symptoms disappeared or diminished. These long term results are competitive with surgery. Three transitory Horner syndromes and one pneumothorax occurred.

Technique of percutaneous phenol block of the recurrent motor branch of the median nerve

Il est frequent d'observer une spasticite en flexion de la main a laquelle participe la spasticite des muscles innerves par le median. L'injection percutanee de phenol dans la branche motrice recurrente du nerf median est une technique dure et efficace pour eliminer la spasticite pendant plusieurs mois, permettant la mobilisation du pouce au cours de la recuperation neurologique

A mechanism of new pain following cordotomy; reference of sensation

An antero-lateral cordotomy was performed on a 62-year-old man who had been suffering from intractable right chest pain caused by lung cancer. Six hours after the cordotomy a new pain occurred in an analogous part of the body on the opposite side; the intensity increased gradually and it became as severe as the original within 1 week. Reference of sensation from analgesic area of cordotomy to the opposite side of the body was induced by noxious stimuli. Intrathecal phenol block to the nerves conveying the cancer pain abolished the new pain and the reference of sensation from this blocked area, though it remained unchanged in other analgesic areas of cordotomy. This substantiates that the new pain was a reference of the original cancer pain.

Phenol block in the treatment of spasticity.

Injection of dilute phenol to peripheral nerves or motor block areas when there is spasticity, can, by damage to the nerves or motor areas, relieve the spastic condition, allow better nursing care, free the patient from the embarrassment of a contorted limb and may allow voluntary movement to take place.

The Masagement of Cancer Related Pain

Some foreign reports state that 60∼87? of patients hospitalized with cancer suffer with pain. The cancer patients usua17y have exacerbation of pain corresponding to the progre-ssion of the disease. The management of cancer relate? pain includes the followings : 1) Attacking the pathologr causin? the pain 2) Raising the pain thresheld 3) Modulating the pain pathway 4) Interrupting the pain pathwazy. The most important aspect in management of cancer related pain is stepladder approach to ana17esic tailoring. The development of toleranoe with prolonged uke of analgesics requires increasing dose of analgesics. Not only does the increased dose of analgesics affect analgesia but also increases side effectg increases. Chemical nerve blocks and neurosurgical ablation can be used in management of terminal cancer patients. With the development of multimodal approaches to caring cancer patients one shruld be cautious in Using ablative therapy. ln our pain clinics, 123 cancer related pain patients have been managed with non-narc-odic analgesics, narcotic analgesics, celiac plexus block, and intrathecal phenol block, imp-lant ation of permanent epidural catheter.

Percutaneous Phenol Block of the Upper Thoracic Sympathetic Chain with Computed Tomography Guidance

Twenty-one percutaneous neurolyses of the upper thoracic sympathetic chain were performed in 12 patients with CT guidance by a single injection of 1 to 3 ml of phenol at the level of Th3. Results were assessed after a follow-up period varying from 4 to 33 months. Three patients with hyperhidrosis had immediate and complete disappearance of symptoms, but only one patient remained dry. In 7/14 procedures done for Raynaud's disease symptoms disappeared or diminished. These long term results are competitive with surgery. Three transitory Horner syndromes and one pneumothorax occurred.

ペインクリニックにおける合併症 ： 予防と対策 くも膜下フェノール注入後に生じたせき髄麻ひ

ペインクリニックにおける合併症 ： 予防と対策 くも膜下フェノール注入後に生じたせき髄麻ひ

Histopathological findings of subarachnoid phenol block on intractable pain patients

Histopathological findings of subarachnoid phenol block on intractable pain patients

Subarachnoid versus combined subarachnoid and epidural phenol block in management op cancer pain

Subarachnoid versus combined subarachnoid and epidural phenol block in management op cancer pain

Study of electrochemical properties and formation of some phenolic block copolymers

AbstractPhenolic block copolymers have been prepared by condensation of p‐cresol‐formaldehyde and p‐toluidine‐formaldehyde homopolymer chains. The compositions of the copolymers have been determined by electrometric titrations in non‐aqueous solvents. Efforts have been made to correlate structural features of the copolymers, such as intramolecular hydrogen bonding, and the probable number of phenolic and aromatic amine units in the respective blocks of the copolymer chain with their titration curves.

Orthopedic strategies in the management of the adult head-injured patient.

The purpose of this paper is to outline a systematic approach to the care of adult patients with traumatic head injury. The orthopedic management of these individuals is divided in three phases. In the acute period after the initial trauma, musculoskeletal injuries should be diagnosed and treated. Delayed diagnoses of fractures and peripheral nerve injuries are common. Fracture care often differs from the care given to patients without head injuries because open reduction and internal fixation are more frequently indicated. The results of fracture treatment are compromised by spasticity and heterotopic ossification. The second phase is the subacute period during which neurologic recovery is occurring. This period may last up to 18 months. While neurologic recovery is proceeding, heterotopic ossification and spasticity with its resulting deformities are treated. Drugs, casting, and phenol blocks of peripheral nerves and motor points are used in the control of spasticity. Drugs and aggressive range-of-motion exercises aid in maintenance of joint motion when heterotopic ossification is present. When neurologic recovery has stabilized, the third phase begins. At this time, residual limb deformities may be surgically corrected and heterotopic bone may be excised.