Chemoneurolysis With Phenol and Alcohol: A “Dying Art” That Merits Revival

Horn, Lawrence J.; Singh, Gurtej; Dabrowski, Edward

doi:10.1891/9781617052422.0010

Cited by 7 publications

(5 citation statements)

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“…The use of intrathecal baclofen pumps can be considered for the treatment of severe generalized spasticity ( 37 ). Other techniques were very commonly used in the past, such as denervation with phenol or ethyl alcohol, but are less commonly used at present given the risk of side effects such as paresthesia or dysesthesia described in the literature ( 38 , 39 ). Techniques such as neuroablation (e.g., DREZotomy) or neuromodulation (e.g., spinal stimulation) are rarely used because they are invasive, carry a higher risk, and their efficacy is poorly established in the literature.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Safety and effectiveness of thermal radiofrequency applied to the musculocutaneous nerve for patients with spasticity

Otero-Villaverde,

Formigo-Couceiro,

Martin-Mourelle

et al. 2024

Front. Neurol.

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ObjectiveEvaluate safety and effectiveness of thermal radiofrequency in the musculocutaneous nerve in patients with focal elbow flexor spasticity.DesignAmbispective observational follow-up study. Patients with focal spasticity secondary to central nervous system injury with elbow flexor pattern who received thermal radiofrequency treatment in the musculocutaneous nerve between 2021 and 2023 were included.Subjects12 patients.MethodsUltrasound-guided thermal radiofrequency was applied to the musculocutaneous nerve at 80°C for 90 s. Effectiveness was assessed prior to thermal radiofrequency and at 6 months using scales to measure pain (VAS), spasticity (MAS), disability (DAS), quality of life (SQol-6D), patient-perceived and physician-perceived satisfaction (PIG-C, PGA), and goal attainment (GAS). Elbow joint range of motion was evaluated via goniometry. Safety was evaluated by assessing side effects.ResultsPatients had statistically significant improvements in spasticity (p = 0.003), severe elbow flexion (p = 0.02), pain (p = 0.046), functioning (p < 0.05), and spasticity-related quality of life (p < 0.05 in three sections). Furthermore, treatment goals were attained. Patient- and physician-perceived clinical improvement was achieved. Regarding side effects, two patients had dysesthesia that was self-limiting, with maximum duration of 1 month.ConclusionThermal radiofrequency in the musculocutaneous nerve can be a safe, effective treatment for patients with severe spasticity with an elbow flexor pattern.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Safety and effectiveness of thermal radiofrequency applied to the musculocutaneous nerve for patients with spasticity

Otero-Villaverde,

Formigo-Couceiro,

Martin-Mourelle

et al. 2024

Front. Neurol.

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“…This, however, can yield a higher final alcohol concentration. It is commonly believed that a resultant concentration of at least 50% alcohol is required for a long-lasting neurolytic effect [ 28 ]. Regarding a possibility of variable alcohol concentrations owing to uneven mixing, the efficacy of this 1:1 ratio between local anaesthetic and absolute alcohol has been illustrated by this study and our first case series [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework

Lin

Sasaki

2022

Healthcare

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Introduction: With an increasingly ageing population, there is a growing impact of fragility hip fracture on the healthcare system and on society as a whole. Oral and injectable analgesics are often insufficient whilst traction and regional blocks do not allow patients to be discharged easily. While the conventional approach of ultrasound-guided anterior hip pericapsular neurolysis can help a lot of inoperable hip fracture patients to relieve their fracture pain and facilitate subsequent nursing care, enormous technical challenges are encountered in some cases. In this retrospective case study, we evaluated the overall pain and functional outcomes of our modified approach of anterior hip pericapsular neurolysis for inoperable hip fractures using the IDEAL framework. Method: This retrospective case series studied patients with acute inoperable hip fracture who received the modified approach of anterior hip pericapsular neurolysis from January 2018 to June 2019 according to the IDEAL recommendations. The modified approach consisted of pericapsular nerve group (PENG) injection, iliopsoas plane infiltration, and the sagittal approach of obturator nerve articular branches (ONAB) injection. Subsequent alcohol neurolysis would be performed in the same setting if there were positive diagnostic blocks. Assessments were carried out on post-intervention day 5. The primary outcome was pain intensity during hip flexion at 80 degrees in the recumbent position and during gentle hip internal and external rotation using an appropriate pain scoring tool. The secondary outcomes were the range of tolerable hip flexion and occurrence of any lower limb neurological deficit because of the procedure. Interim outcomes were also briefly evaluated. Results: Among the 74 patients who were reviewed in the study period, the median dynamic pain at hip flexion 80° (p < 0.001) and on gentle hip external and internal rotation (p < 0.001) was significantly reduced from a composite score of 3 (severe pain) to 1 (mild pain) on post-intervention day 5 after the modified approach of hip neurolysis. This translated to 72% of patients achieving satisfactory pain control, which was defined as a composite pain score of ≤1 on hip flexion at 80°. Functionally, the mean range of tolerable hip flexion significantly improved from 39.7° at baseline to 74° on post-intervention day 5 (p < 0.001). Transient and reversible hypotension was seen in about 10% of the patients. No other major procedural adverse event was noted. Interim follow-up at 4–6 months post-intervention revealed that more than 95% of patients continued to have satisfactory dynamic pain control (i.e., composite pain score ≤ 1). According to the IDEAL classification, this study could be ranked as stage 2a (development). Conclusions: Our findings suggested that anterior hip pericapsular neurolysis using a modified approach could offer consistent and satisfactory analgesic and functional benefits to a majority of patients with inoperable hip fractures during the interim of the fracture healing process, and it was potentially safer than the conventional approach. This technique might have achieved its readiness to proceed to the next stage of research according to the IDEAL framework.

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“…For focal spasticity, focal treatment is preferred, mainly with botulinum toxin A (BoNT-A) [128]. Historically phenol or alcohol injections were quite common [129,130] , but with the development of BoNT-A, this is more rarely used. BoNT-A is used for a vast array of indications in addition to spasticity, including a number of off-label indications.…”

Section: Pharmacological Treatment For Focal Spasticitymentioning

confidence: 99%

Studies on Spasticity from an Interventional Perspective

Ertzgaard

2018

Linköping University Medical Dissertations

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This thesis focuses on interventional aspects of spasticity, but has a very holistic approach, grounded in the specialty of Rehabilitation medicine. This means capturing the effects of spasticity, on such a complex biological system as the human being, living in a psychosocial context affecting the situation. When evaluating spasticity there are a number of levels of evidence. The first of course, understanding what we mean with spasticity, where there unfortunately is no consensus. The second level is to study if our treatments affect spasticity in a positive direction. The third is to grasp if a decrease in spasticity improve or normalize patient's movement patterns. The fourth level investigates if improvement in movement patterns improve patient's ability to perform activities; and the fifth level, comprising whether this intervention improves life satisfaction. Finally, on a societal level, we wish to investigate whether the improvement in life satisfaction or health related quality of life would motivate society to fund the intervention. Paper I on Goal Attainment Scaling pointed out necessary aspects to consider when using this instrument. This relates, among other things, to the need of learning ("the art of") goal setting and deciding the purpose of the measurements. Research and clinical use puts different demands on the instrument, for the latter time-efficiency and simplicity to use being most important. For research, it is important to be able to register deterioration, and this can be achieved using the 6-step version.

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Chemoneurolysis With Phenol and Alcohol: A “Dying Art” That Merits Revival

Cited by 7 publications

References 0 publications

Safety and effectiveness of thermal radiofrequency applied to the musculocutaneous nerve for patients with spasticity

Safety and effectiveness of thermal radiofrequency applied to the musculocutaneous nerve for patients with spasticity

A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework

Studies on Spasticity from an Interventional Perspective

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