Phenol block in the management of spastic cerebral palsy

Yadav, Shiv Lal; Singh, Ujjwal Kumar; Dureja, G. P.; Singh, Kunal; Chaturvedi, Sanjay

doi:10.1007/bf02752218

Cited by 48 publications

(14 citation statements)

References 12 publications

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“…reported an average period of effectiveness to be 13 months (range 3-18 months) with 6% phenol in 115 cases of cerebral palsy. [9] None of the studies have evaluated the effect of obturator neurolysis over spasm frequency in the internal rotators of hip, which decreased significantly in our study. The spasms disturb the function of sitting at early stages of rehabilitation and walking.…”

Section: Discussionmentioning

confidence: 76%

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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Section: Discussionmentioning

confidence: 76%

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

et al. 2013

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“…20,[28][29][30][31] Phenol use in children and adults with spasticity is primarily directed toward nerves that have a minimal sensory component and are easily localizable. Successful results have been reported in patients with multiple etiologies, including multiple sclerosis, stroke, torticollis, brain injury, and cerebral palsy.…”

Section: Indicationsmentioning

confidence: 99%

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

et al. 2003

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The purpose of this article is to describe outcomes of intrathecal baclofen therapy for 29 patients with cerebral palsy, focusing on impairments, functional limitations, and disability. Patients received individualized rehabilitation and were followed up to 24 months. The primary outcome measures were the Ashworth Scale and the functional skills and caregiver assistance scales of the Pediatric Evaluation of Disability Inventory (PEDI). Ashworth Scale scores were significantly reduced (P < or = .0005). All areas of functional skills and caregiver assistance improved. Comparing groups of adults and patients less than 18 years, there were no significant differences, but there was a relationship between age and dose. Comparing groups of patients in high and low levels of independent functional mobility, no significant differences were found. These results provide suggestive evidence that the combination of intrathecal baclofen therapy and rehabilitation has positive effects across the dimensions of disablement. This study serves as a basis for high-level scientific studies of these effects.

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“…Clinical Experience Botulinum A toxin has been used in cerebral palsy (1) to diminish painful paravertebral spasticity,9 (2) to facilitate positioning and hygiene,9 (3) to improve ambulation, 8-1O,12-14,43 (4) as an alternative to serial casting,&dquo; (5) as a diagnostic aid to determine the efficacy of surgery,' (6) to augment or reduce therapy,44 (7) to facilitate or replace bracing,44 (8) to delay surgery,44 and (9) to improve upper extremity function. 15 Studies have demonstrated that botulinum A toxin injected intramuscularly without anesthesia is practical in a clinical setting8-1O,12 and appears to alter favorably the natural history of patients with dynamic foot deformity.…”

Section: Botulinum a Toxinmentioning

confidence: 99%

“…The use of botulinum A toxin is inappropriate or inadvisable (1) in the management of fixed contracture, (2) in the presence of certain specific neuromuscular diseases (eg, myasthenia gravis), (3) while a patient is actively being treated with medications that may exaggerate the response to neuromuscular blocking agents (eg, aminoglycoside antibiotics), (4) in muscle(s) that did not respond to alcohol or phenol injections, (5) in the presence of antibodies to botulinum A toxin, and/or (6) in the absence of objective benefit. SUMMARY Neuromuscular blocking agents have an important adjunctive role in the evaluation and nonoperative management of patients with S28 cerebral palsy.…”

Section: Contraindicationsmentioning

confidence: 99%

Notice

1996

J Child Neurol

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Neuromuscular blocking agents-45% alcohol, 4% to 6% aqueous phenol, local anesthetics, and botulinum A toxin—have been used for many years in the evaluation and management of spasticity and movement disorders in children with cerebral palsy. Recent reports suggest that longer-acting neuromuscular blocking agents may impact positively on the natural history of dynamic deformity and improve health-related quality of life. This review includes the mechanism of action, techniques, indications, complications, and clinical outcomes associated with these agents. (J Child Neurol 1996;11(Suppl 1):S23-S28).

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Phenol block in the management of spastic cerebral palsy

Cited by 48 publications

References 12 publications

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

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

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

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