Peripheral nerve block with phenol to treat spasticity in spinal cord injured patients

Gündüz, Şükrü; Kalyon, Tunc Alp; Dursun, Hasan; Möhür, Haydar; Bilgic, F. Ayzer

doi:10.1038/sc.1992.156

Cited by 21 publications

(11 citation statements)

References 3 publications

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“…Patients suffering from spasticity often seek neurolysis, the permanent destruction of the sciatic nerve, in order to improve self-care, balance and global rehabilitation [1–5]. The current methods of neurolysis range from extremely invasive procedures such as neurosurgery [5] to minimally invasive options such as chemical injection [1–4] and thermal ablation [6–8].…”

Section: Introductionmentioning

confidence: 99%

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Feasibility Study on MR-Guided High-Intensity Focused Ultrasound Ablation of Sciatic Nerve in a Swine Model: Preliminary Results

Kaye

Gutta

Monette

et al. 2015

Cardiovasc Intervent Radiol

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Introduction Spastic patients often seek neurolysis, the permanent destruction of the sciatic nerve, for better pain management. MRI-guided High Intensity Focused Ultrasound (MRgHIFU) may serve as a noninvasive alternative to the prevailing, more intrusive techniques. This in vivo acute study is aimed at performing sciatic nerve neurolysis using a clinical MRgHIFU system. Methods The HIFU ablation of sciatic nerves was performed in swine (n=5) using a HIFU system integrated with a 3 T MRI scanner. Acute lesions were confirmed using T1-weighted contrast-enhanced (CE) MRI and histopathology using hematoxylin and eosin staining. The animals were euthanized immediately following post-ablation imaging. Results Reddening and mild thickening of the nerve and pallor of the adjacent muscle were seen in all animals. The HIFU-treated sections of the nerves displayed nuclear pyknosis of Schwann cells, vascular hyperemia, perineural edema, hyalinization of the collagenous stroma of the nerve, myelin sheet swelling and loss of axons. Ablations were visible on CE MRI. Non-perfused volume of the lesions (5.8 cc – 64.6 cc) linearly correlated with estimated lethal thermal dose volume (4.7 cc – 34.2 cc). Skin burn adjacent to the largest ablated zone was observed in the first animal. Bilateral treatment time ranged from 55–138 minutes, and preparation time required 2 hours on average. Conclusion The acute pilot study in swine demonstrated the feasibility of a noninvasive neurolysis of the sciatic nerve by using a clinical MRgHIFU system. Results revealed that acute HIFU nerve lesions were detectable on CE MRI, gross pathology and histology.

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Section: Introductionmentioning

confidence: 99%

“…The current methods of neurolysis range from extremely invasive procedures such as neurosurgery [5] to minimally invasive options such as chemical injection [1–4] and thermal ablation [6–8]. However, all these methods are associated with risks of infection, bleeding and damage to other organs [9, 10].…”

Section: Introductionmentioning

confidence: 99%

Feasibility Study on MR-Guided High-Intensity Focused Ultrasound Ablation of Sciatic Nerve in a Swine Model: Preliminary Results

Kaye

Gutta

Monette

et al. 2015

Cardiovasc Intervent Radiol

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“…on 36 spastic patients using 2-3 ml of 5% phenol, the neurolysis findings regressed through the end of 2 nd month. [11] The difference could be explained by the less volume of phenol used. Trainer et al .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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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.

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“…A significant improvement was found in the clinical findings of the present study, which lasted until the third month, when some parameters began to approach the initial values. In a study of Gündüz et al 20 on spastic patients using 2–3 ml 5% aqueous solution of phenol, the authors performed 41 electromyography‐guided ON neurolysis. The neurolysis findings regressed through the end of the second month.…”

Section: Discussionmentioning

confidence: 99%

Neurolytic phenol blockade of the obturator nerve for severe adductor spasticity

Akkaya

Ünlü

Alptekin

et al. 2009

Acta Anaesthesiol Scand

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Peripheral nerve block with phenol to treat spasticity in spinal cord injured patients

Cited by 21 publications

References 3 publications

Feasibility Study on MR-Guided High-Intensity Focused Ultrasound Ablation of Sciatic Nerve in a Swine Model: Preliminary Results

Feasibility Study on MR-Guided High-Intensity Focused Ultrasound Ablation of Sciatic Nerve in a Swine Model: Preliminary Results

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

Neurolytic phenol blockade of the obturator nerve for severe adductor spasticity

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