Neurolytic Blocking Agents: Uses and Complications

Molloy, Robert E.; Benzon, Honorio T.

doi:10.1016/b978-032304184-3.50048-0

Cited by 6 publications

(6 citation statements)

References 103 publications

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“…20 Chemical neurolysis is generally achieved using alcohol (50% to 100%) or phenol (5% to 10%) that provides effective pain control for 3 to 6 months. 21,22 No significant difference in efficacy between alcohol and phenol was reported, while the risk of neuritis, which is one of the major side effects of this procedure, was found to be lower with phenol use. 20,23 Therefore, we preferred 6% phenol solution for our patients.…”

Section: Discussionmentioning

confidence: 97%

<p>Pain Control with Splanchnic Neurolysis in Pancreatic Cancer Patients Unresponsive to Celiac Plexus Neurolysis</p>

Comlek¹

2020

JPR

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Background/Aims In most instances of abdominal pain associated with pancreatic cancer, pain may become refractory to increasing doses of narcotics. Celiac plexus neurolysis represents an option; however, altered celiac plexus anatomy may render this treatment infeasible or ineffective, where splanchnic nerve neurolysis may represent another option. This study aimed to investigate the outcomes of splanchnic neurolysis in pancreatic cancer patients not responsive to celiac plexus neurolysis. Patients and Methods Among all 84 patients who underwent celiac plexus neurolysis for pancreatic cancer pain during the study period, 34 patients did not respond and underwent splanchnic nerve neurolysis under fluoroscopic guidance and thus included in this retrospective study. Stage IV, III, and II disease was present in 38.2%, 47.1%, and 14.7% of the patients. During the study, 88.2% were receiving chemotherapy, whereas none were on radiotherapy. Data for daily narcotic dose equivalents and Visual Analogue Scale (VAS) scores during outpatient visits at baseline, 2 weeks, 2 months, and 3 months were extracted. Results Pain response rates were 76.5%, 84.4%, and 71.0%, at 2 weeks, 2 months, and 3 months, respectively. A significant and dramatic reduction was seen in VAS scores at 2 weeks (2.8±1.2 versus 6.3±1.1, p<0.001), and this significant decline was maintained for 3 months. Similarly, a significant and dramatic reduction was seen in daily narcotic need at 2 weeks (20.8±32.9 versus 93.4±86.2 mg, p<0.001), which was also maintained during the 3-month follow-up. The procedure was generally well tolerated. Conclusion Findings of this study suggest that splanchnic neurolysis represents a durable and effective option for pain control in pancreatic cancer patients in whom the neurolysis of the celiac plexus is ineffective. However, these conclusions refer to only preliminary single-center results in a selected patient group; thus, further large studies are warranted.

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Section: Discussionmentioning

confidence: 97%

<p>Pain Control with Splanchnic Neurolysis in Pancreatic Cancer Patients Unresponsive to Celiac Plexus Neurolysis</p>

Comlek¹

2020

JPR

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“…Whereas this was expected with alcohol neurolysis, which depends on Wallerian degeneration as its primary mechanism for neurolysis, we believed that RFA would lead to consistent neurolysis. 16 It is possible that thermal lesions may evolve over time. Furthermore, anatomy may prevent thermal lesions from reliably creating neurolysis of the intercostal nerve.…”

Section: Discussionmentioning

confidence: 99%

Novel Use of Noninvasive High-Intensity Focused Ultrasonography for Intercostal Nerve Neurolysis in a Swine Model

Gulati

Loh

Gutta

et al. 2014

Regional Anesthesia and Pain Medicine

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“…The size of the lesions varies according to the concentration, and therefore the quantity. The two neurolytic agents most widely used in the treatment of chronic pain are phenol and alcohol, producing a block that lasts 3–6 months [ 96 ]. Major drawbacks with the use of these agents include: necrosis of surrounding tissue, neuritis, and uncontrolled diffusion (83).…”

Section: Interventional Managementmentioning

confidence: 99%

Facet joint syndrome: from diagnosis to interventional management

et al. 2018

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Low back pain (LBP) is the most common pain syndrome, and is an enormous burden and cost generator for society. Lumbar facet joints (FJ) constitute a common source of pain, accounting for 15–45% of LBP. Facet joint degenerative osteoarthritis is the most frequent form of facet joint pain. History and physical examination may suggest but not confirm facet joint syndrome. Although imaging (radiographs, MRI, CT, SPECT) for back pain syndrome is very commonly performed, there are no effective correlations between clinical symptoms and degenerative spinal changes. Diagnostic positive facet joint block can indicate facet joints as the source of chronic spinal pain. These patients may benefit from specific interventions to eliminate facet joint pain such as neurolysis, by radiofrequency or cryoablation. The purpose of this review is to describe the anatomy, epidemiology, clinical presentation, and radiologic findings of facet joint syndrome. Specific interventional facet joint management will also be described in detail.Teaching points • Lumbar facet joints constitute a common source of pain accounting of 15–45%. • Facet arthrosis is the most frequent form of facet pathology. • There are no effective correlations between clinical symptoms, physical examination and degenerative spinal changes. • Diagnostic positive facet joint block can indicate facet joints as the source of pain. • After selection processing, patients may benefit from facet joint neurolysis, notably by radiofrequency or cryoablation.

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Neurolytic Blocking Agents: Uses and Complications

Cited by 6 publications

References 103 publications

<p>Pain Control with Splanchnic Neurolysis in Pancreatic Cancer Patients Unresponsive to Celiac Plexus Neurolysis</p>

<p>Pain Control with Splanchnic Neurolysis in Pancreatic Cancer Patients Unresponsive to Celiac Plexus Neurolysis</p>

Novel Use of Noninvasive High-Intensity Focused Ultrasonography for Intercostal Nerve Neurolysis in a Swine Model

Facet joint syndrome: from diagnosis to interventional management

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