A complication of subarachnoid phenol blockade

Abstract

Ever since the original description by Maher' of subarachnoid phenol blockade for the relief of intractable pain, its use has been accepted. Most subsequent descriptions of the technique testify to the good results allied with comparative safety of the procedure. Nonetheless, there have been well documented complications to phenol blockade2-which limit its use only to patients who satisfy fairly stringent criteria; the side effects depend naturally, upon the site of injection and dosage of phenol, but as the following case description will show, undesirable extension of the neural block especially when phenol is used near the upper spinal cord may have fatal consequences. Case ReportFollowing development of pain in the right arm, a 66-year-old woman was found to have a mass at the apex of the right lung which had destroyed the adjacent portion of the first rib. A diagnosis of Pancoast tumour was made and she was treated with radiotherapy, after which surgical excision was undertaken of the thoracic mass together with portions of the upper four ribs on the right side, and the lower division of the brachial plexus. Tissue at the site of this suspected neoplasm was found to be replaced by acellular hyaline material and scar. Six months after surgery, there was still severe pain in the right arm and pectoral region and she was accordingly referred to the department of anaesthesia to see if her pain could be ameliorated.It was decided that a right cervical posterior neurolysis should be performed using phenol in glycerine. In order to do this a modified version of the technique described by Maher4 was used.The patient was placed in the lateral position with her affected (right) side down and with approximately 15 degrees of head-up tilt. A subarachnoid puncture was done using a short bevelled 18-gauge needle. At the stage that cerebrospinal fluid was obtained the needle was very gently pulled back until the flow of cerebrospinal fluid was greatly diminished. One ml of iophendylate (Myodil) was injected and X-ray control showed the typical 'doubleline' picture of iophendylate in both the subarachnoid and extra-arachnoid (subdural) space. One ml 6% phenol in glycerine was injected and then over a period of 5 min incremental doses of 0.5 ml up to a total dose of 3 ml were added before she started to obtain pain relief. Within five minutes of the end of the injection the patient had described almost complete pain relief but then suddenly suffered respiratory arrest. She was immediately turned on her back, the trachea intubated and the lungs ventilated. Adequate spontaneous respiratory movements returned within one hour but then gradually

Cancer Pain

“…105 A hyperbaric phenol saddle block is relatively simple to perform and is particularly suitable for many patients with a colostomy and urinary diversion. 105 A hyperbaric phenol saddle block is relatively simple to perform and is particularly suitable for many patients with a colostomy and urinary diversion.…”

Functional Assessment Following Intrathecal Baclofen Therapy in Children With Spastic Cerebral Palsy

“…8,27,32 Significant dysesthesia occurs more frequently in mixed sensory and motor nerve blocks than in pure motor or intramuscular blocks. 40 An understanding of the safety profile, symptoms of overdose, and techniques required is of utmost importance. 38 It is speculated that the mechanism of persistent pain is related to abnormal reinnervation or partially blocked sensory nerves.…”