Evaluation of interadductor approach in neurolytic blockade of obturator nerve in spastic patients

Abstract

Background:Spasticity is a syndrome associated with a persistent increase in involuntary reflex activity of a muscle in response to stretch. Adductor muscle spasticity is a common complication of spinal cord and brain injury. It needs to be treated if it interferes with activities of daily living and self-care. Obturator neurolytic blockade is one of the cost-effective therapeutic possibilities to treat spasticity of adductor group of muscles. In this study, we assessed the efficacy of interadductor approach in alleviating the spasticity.Methods:Obturator neurolysis using 8-10 ml 6% phenol was given with the guidance of a peripheral nerve stimulator in 20 spastic patients. Technical evaluation included number of attempted needle insertions, time to accurate location of the nerve, depth of needle insertion, and success rate. Pain, spasticity, hip abduction range of motion (ROM), number of spasms, gait, and hygiene were evaluated at 1st hour, 24th hour, end of the 1st week, and in the 1st, 2nd, and 3rd months following the intervention.Results:The success rate was 100% with mean time to accurate nerve location 4.9±2.06 min. Average depth of needle insertion was 2.91±0.32 cm. Compared with the scores measured immediately before the block, all studied parameters improved significantly. An increase in the Modified Ashworth Scale values was observed in the 2nd and 3rd months, but they did not reach their initial values.Conclusion:The interadductor approach proved to be accurate and fast, with a high success rate. Phenol blockade is an efficient and cost-effective technique in patients with adductor spasticity. It 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.

Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review

“…Studies by Ghai et al 35 and Wassef et al 38 included participants with non-SCI spasticity. As SCI participants comprised ⩾ 50% of the samples, and we were unable to obtain patient level data, data pertaining to the entire subject group were included.…”

“…As SCI participants comprised ⩾ 50% of the samples, and we were unable to obtain patient level data, data pertaining to the entire subject group were included. Ghai et al, 35 Yasar et al 39 and Uchikawa et al 37 used MAS as a primary outcome measure, otherwise selection of outcome measures was variable between studies. The three case studies [42][43][44] did not report formal outcome measures and instead provided qualitative descriptions.…”

“…Chemodenervation in spinal cord injury J Lui et al individuals with SCI have been reported in four level 4 pre-post studies [35][36][37][38] and six level 5 studies (5 case series/studies, [40][41][42][43][44] one retrospective chart review 39 ). Results from these studies are summarized in Table 3.…”

“…Nine studies investigated the use of BoNT, [26][27][28][29][30][31][32][33][34] and 10 studies investigated phenol/alcohol [35][36][37][38][39][40][41][42][43][44] for management of spasticity in SCI with chemodenervation. The literature search did not identify any randomized or non-RCTs looking at management of spasticity in a sample population with ⩾ 50% SCI participants, precluding the use of PEDro and Downs and Black Scale for quality assessment.…”

“…Results from these studies are summarized in Table 3. Seven [35][36][37][38][39]41,43 of the 10 studies involved phenol injections ranging from 0.3 to 10 ml and 5 to 6% concentration. Alcohol concentration used in three case series/studies 40,42,44 ranged from 68 to 100%, with volumes between 7.5 and 10 ml.…”