Ultrasound and Electrical Stimulator-Guided Obturator Nerve Block With Phenol in the Treatment of Hip Adductor Spasticity in Long-Term Care Patients: A Randomized, Triple Blind, Placebo Controlled Study

Lam, Kuen; Wong, D. C. T.; Tam, Cheuk Kwan; Wah, Shu Hong; Myint, Ma Wai Wai; Yu, Teresa Kim Kam; So, Kar Kui; Cheung, Gloria; Au, Kai Man; Fu, Ming Hung; Wu, Yee Ming; Kng, Carolyn

doi:10.1016/j.jamda.2014.10.005

Cited by 28 publications

(23 citation statements)

References 24 publications

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“…They also denote how the dynamic nature of ultrasound imaging can help not only optimize safety profiles by preventing vascular injury and administration, but also facilitate better outcomes by ensuring phenol delivery immediately proximal to target motor branches. This precision of phenol delivery is thought to be resultant of direct and dynamic visual identification of target motor branches with ultrasound imaging, which is not possible with EStim‐guidance alone . Thus EStim guidance may require larger phenol volumes to ensure medication spread to motor branches and achieve appropriate efficacy .…”

Section: Discussionmentioning

confidence: 99%

“…It is thought that the precise localization of neurolysis to pure motor branches may mitigate dysesthesia risk by preserving sensory nerve conduction. 2,[8][9][10][11][12][13] Dysesthesia prevention, or at the very least reduction, has been demonstrated successfully by others who utilized precise localization techniques to avoid sensory branches. [8][9][10][11][12][13]15 Deltombe et al published their experiences with equinovarus foot spasticity patterns in 12 patients being treated with EStim-guided anesthetic blocks to motor branches as identified by computerized tomography.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,7 There is some thought that precise localization of pure motor branches with ultrasound guidance may mitigate dysesthesia risk. [8][9][10][11][12][13] The precision of this localization may also be further enhanced with concomitant electrical stimulation (EStim) guidance. [11][12][13] Consequently, our study aimed to analyze practice patterns and adverse effects of phenol neurolysis to distal upper extremity nerves using concomitant ultrasound and EStim guidance.…”

Section: Introductionmentioning

confidence: 99%

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Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Karri

Zhang

2019

PM&R

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Background When managing patients with focal spasticity, phenol neurolysis is often avoided largely because of its presumed poor adverse effect profile. It is suggested that dysesthesias may be more common with phenol neurolysis of the mixed sensorimotor nerves (eg, radial, median, and ulnar nerves) compared to neurolysis of pure motor nerves. However, these risks may be mitigated with precise localization of pure motor branches by ultrasound and electrical stimulation (EStim). Objective To explore practice patterns of phenol neurolysis to distal upper extremity mixed sensorimotor nerves with ultrasound and EStim guidance. Design A retrospective analysis of all neurolysis procedure records at a single institution from January 2013 to February 2018. Demographic and clinical variables including primary neurological diagnosis, concurrent spasticity treatments, nerves injected, phenol dosage and adverse events were abstracted from the electronic medical records. Participants 57 patients who received phenol neurolysis with ultrasound and EStim guidance for spasticity management to radial, median, or ulnar nerves. Main Outcome Measures Reported adverse effects. Results A total of 57 patients who collectively received neurolysis to 139 nerves across 102 encounters, met inclusion criteria. Most prevalent diagnoses included traumatic brain injury (N = 27, 47.4%) and stroke (N = 18, 31.6%), with a smaller subset having spinal cord injury (N = 10, 17.5%). Most patients received concomitant chemodenervation with botulinum toxin (N = 44, 77.2%). The average phenol dosage per nerve was 1.8 mL, with a range of 0.5‐9.0 mL. Reported adverse effects included three cases of prolonged pain, but no dysesthesias were reported during the follow‐up period (>40 days). Conclusions Phenol neurolysis with ultrasound and EStim guidance was successfully and safely used to manage focal spasticity in the distal upper extremity. Level of Evidence III.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Karri

Zhang

2019

PM&R

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“…Neurolysis is a common clinical treatment for spasticity, and comprises injections of alcohol or phenol into the relevant nerve trunk or nerve entry points (NEPs); motor points). This treatment produces myelin loss, axonal degeneration, and ultimately results in local neuromuscular activity deficits (Kocabas et al, 2010;Lee & Jang, 2012;Lam et al, 2015). However, nerve trunk injections can produce a variety of complications including sensory paralysis, thrombosis following accidental injection into local blood vessels, and even local muscle fibrosis or contracture resulting from repeated injections (Yalcin et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…However, the success of the neurolysis procedure depends on accurate localization of NEPs. Currently, general anatomical descriptions of muscle shapes and nerve trunk courses, gross anatomical measurements of NEPs, and ultrasound or electrical stimulator guidance permit only rough estimations of actual NEP locations (Yoo et al, 2002;Song et al, 2014;Lam et al). Therefore, inaccurate localization is a considerable risk and exploratory puncture is often required for confirmation of NEP locations.…”

Section: Introductionmentioning

confidence: 99%

A Novel Method for Localizing Nerve Entry Points During Spasticity Treatment

Yang

Tian

et al. 2017

Int. J. Morphol.

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YANG, S.; HU, S; TIAN, X. & HU, S.A novel method for localizing nerve entry points during spasticity treatment. Int. J. Morphol., 35(3):799-803, 2017. SUMMARY:The nerve entry points (NEPs) cannot be accurately localized for the treatment of muscle spasticity in neurolysis. The aim of this study was to develop a new method of accurately localizing nerve entry points in relation to bony landmarks. NEPs in human cadavers were coated with barium sulfate. Method 1 consisted of horizontal and longitudinal reference lines being designated based on bony landmarks, followed by radiography and measurements using picture archiving and communication system software. Method 2 involved sewing the barium sulfate-soaked suture thread into the skin to designate the horizontal and longitudinal reference lines, followed by computed tomography (CT) scanning to determine the skin surface location and puncture depth for the NEPs. Using method 1, the bony landmarks and nerve muscular branches labeled with barium sulfate were clearly visualized by radiography. NEPs were localized using the reference lines, but the resultant points were not on the skin surface, and information was not provided regarding puncture depth. Method 2 resulted in the bony landmarks, NEPs, and reference lines being clearly visualized using CT imaging. The NEPs were successfully projected onto the skin surface and localized using reference lines that were measured along the curve of the skin. Furthermore, method 2 provided measurements of puncture depth. NEPs, including depths, can be accurately localized in cadavers using CT. Therefore, this novel method is recommended for localizing neurolysis target points.

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Localization of nerve entry points as targets to block spasticity of the deep posterior compartment muscles of the leg

Zhuo

Zhang

et al. 2017

Clinical Anatomy

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To identify the optimal body surface puncture locations and the depths of nerve entry points (NEPs) in the deep posterior compartment muscles of the leg, 60 lower limbs of thirty adult cadavers were dissected in prone position. A curved line on the skin surface joining the lateral to the medial epicondyles of the femur was taken as a horizontal reference line (H). Another curved line joining the lateral epicondyle of the femur to the lateral malleolus was designated the longitudinal reference line (L). Following dissection, the NEPs were labeled with barium sulfate and then subjected to spiral computed tomography scanning. The projection point of the NEP on the posterior skin surface of the leg was designated P, and the projection in the opposite direction across the transverse plane was designated P'. The intersections of P on H and L were identified as P and P , and their positions and the depth of the NEP on PP' were measured using the Syngo system and expressed as percentages of H, L, and PP'. The P points of the tibial posterior, flexor hallucis longus and flexor digitorum longus muscles were located at 38.10, 46.20, and 55.21% of H, respectively. The P points were located at 25.35, 41.30, and 45.39% of L, respectively. The depths of the NEPs were 49.11, 54.64, and 55.95% of PP', respectively. The accurate location of these NEPs should improve the efficacy and efficiency of chemical neurolysis for treating spasticity of the deep posterior compartment muscles of the leg. Clin. Anat. 30:855-860, 2017. © 2017 Wiley Periodicals, Inc.

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Ultrasound and Electrical Stimulator-Guided Obturator Nerve Block With Phenol in the Treatment of Hip Adductor Spasticity in Long-Term Care Patients: A Randomized, Triple Blind, Placebo Controlled Study

Cited by 28 publications

References 24 publications

Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

A Novel Method for Localizing Nerve Entry Points During Spasticity Treatment

Localization of nerve entry points as targets to block spasticity of the deep posterior compartment muscles of the leg

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