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Li S, Winston P, Mas MF. Spasticity Treatment Beyond Botulinum Toxins. Phys Med Rehabil Clin N Am 2024; 35:399-418. [PMID: 38514226 DOI: 10.1016/j.pmr.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Botulinum toxin (BonT) is the mainstream treatment option for post-stroke spasticity. BoNT therapy may not be adequate in those with severe spasticity. There are a number of emerging treatment options for spasticity management. In this paper, we focus on innovative and revived treatment options that can be alternative or complementary to BoNT therapy, including phenol neurolysis, cryoneurolysis, and extracorporeal shock wave therapy.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center - Houston, Houston, TX, USA; TIRR Memorial Herman.
| | - Paul Winston
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Victoria, British Columbia, Canada; Canadian Advances in Neuro-Orthopedics for Spasticity Consortium, Victoria, British Columbia, Canada
| | - Manuel F Mas
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
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Wie C, Ghanavatian S, Pew S, Kim A, Strand N, Freeman J, Maita M, Covington S, Maloney J. Interventional Treatment Modalities for Chronic Abdominal and Pelvic Visceral Pain. Curr Pain Headache Rep 2022; 26:683-691. [PMID: 35788892 DOI: 10.1007/s11916-022-01072-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Chronic abdominal and pelvic visceral pain is an oftentimes difficult to treat pain condition that requires a multidisciplinary approach. This article specifically reviews the interventional treatment options for pain resulting from visceral abdominal and pelvic pain. RECENT FINDINGS Sympathetic nerve blocks are the main interventional option for the treatment of chronic abdominal and pelvic visceral pain. Initially, nerve blocks are performed, and subsequently, neurolytic injections (alcohol or phenol) are longer term options. This review describes different techniques for sympathetic blockade. Neuromodulation is a potential option via dorsal column stimulation or dorsal root ganglion stimulation. Finally, intrathecal drug delivery is sometimes appropriate for refractory cases. This paper will review interventional options for the treatment of chronic abdominal and pelvic visceral pain.
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Affiliation(s)
- Christopher Wie
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA.
| | - Shirin Ghanavatian
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Scott Pew
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Alexander Kim
- Department of Anesthesiology Brigham and Women's Hospital, Boston, MA, USA
| | - Natalie Strand
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - John Freeman
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Mostafa Maita
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Stephen Covington
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Jillian Maloney
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
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3
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Woodford R, Curley D. Revisiting intrathecal neurolysis for refractory cancer pain: A case series. PROGRESS IN PALLIATIVE CARE 2020. [DOI: 10.1080/09699260.2020.1814062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rachel Woodford
- St George Cancer Care Centre, St George Hospital, Kogarah, Australia
| | - Daniel Curley
- Coffs Harbour Health Campus, Coffs Harbour, Australia
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Szabó I, Varga C. Finding possible pharmacological effects of identified organic compounds in medicinal waters (BTEX and phenolic compounds). INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:989-995. [PMID: 31673767 PMCID: PMC7266787 DOI: 10.1007/s00484-019-01808-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/15/2019] [Accepted: 08/17/2019] [Indexed: 05/09/2023]
Abstract
Medicinal thermal waters consist of a mixture of different organic and inorganic compounds. Traditionally, these waters are only characterized and classified by their inorganic composition; however, the bioavailability of the majority of these inorganic compounds is limited. Many authors investigate the organic fractions of thermal waters. These authors propose that these compounds have a potential effect on health. To elucidate the underlying mechanisms, it is crucial to know the composition of the organic fractions. The absorption of these compounds on intact skin or mucosa is notable. Some of them have local anaesthetic effect or affect receptors in the central nervous system. In the knowledge of the chemical composition, we are able to estimate the possible pharmacological effect or might be able to assess possible toxicity risks. In the present article, we aim to review possible health effects of two of the identified organic fractions: benzene and alkylbenzenes and phenolic compounds that might correlate with the therapeutic effect on rheumatological or other diseases.
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Affiliation(s)
- István Szabó
- Department of Environmental Health, Institute of Public Health Medicie, Medical School, University of Pécs, 12. Szigeti St., Pécs, H7624, Hungary.
| | - Csaba Varga
- Department of Environmental Health, Institute of Public Health Medicie, Medical School, University of Pécs, 12. Szigeti St., Pécs, H7624, Hungary
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Samaila EM, Ambrosini C, Negri S, Maluta T, Valentini R, Magnan B. Can percutaneous alcoholization of Morton's neuroma with phenol by electrostimulation guidance be an alternative to surgical excision? Long-term results. Foot Ankle Surg 2020; 26:314-319. [PMID: 31064701 DOI: 10.1016/j.fas.2019.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/26/2019] [Accepted: 04/07/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Percutaneous alcoholization with phenol by electrostimulation guidance for the treatment of Morton's neuroma is proposed to determine a permanent chemical neurolysis. METHODS 115 patients for 125 Morton's neuromas were treated. Ten patients were affected by multiple neuromas. Visual Analogue Scale and AOFAS score were used for the clinical assessment. RESULTS The mean follow-up was 8,3 years. The pre-alcoholization VAS was 85.84 ± 12.00, while at follow-up scored 28.85 ± 31.35, showing a significant decrease improving in 113/125 cases (90.4%). Treatment was considered successful with a reduction of the VAS value superior to 50% in 89 out of 125 patients (71.2%). The mean overall AOFAS score at -up was 85.09 ± 13.41. CONCLUSIONS Needle-electrode guided percutaneous alcoholization is an outpatient, minimally invasive procedure with low rate of complications. Better results of those obtained with traditional conservative treatments and comparable with those reported with other alcohols injections or surgical nerve excision were observed. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | - Carlo Ambrosini
- Department of Orthopedics and Trauma Surgery, University of Verona, Italy
| | - Stefano Negri
- Department of Orthopedics and Trauma Surgery, University of Verona, Italy
| | - Tommaso Maluta
- Department of Orthopedics and Trauma Surgery, University of Verona, Italy
| | - Roberto Valentini
- Department of Orthopedics and Trauma Surgery, University of Verona, Italy
| | - Bruno Magnan
- Department of Orthopedics and Trauma Surgery, University of Verona, Italy.
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Cyganowski P, Lesniewicz A, Dzimitrowicz A, Wolska J, Pohl P, Jermakowicz-Bartkowiak D. Molecular reactors for synthesis of polymeric nanocomposites with noble metal nanoparticles for catalytic decomposition of 4-nitrophenol. J Colloid Interface Sci 2019; 541:226-233. [PMID: 30690266 DOI: 10.1016/j.jcis.2019.01.097] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/29/2022]
Abstract
HYPOTHESIS A new, facile in-situ method for synthesis of polymeric nanocomposites (NCs) with nanoparticles (NPs) of Au, Pt and Pd is proposed. The method involves reduction-coupled sorption of Au(III), Pt(VI), and Pd(II), which avoids diffusion limitations, allowing the precipitation and stabilization of the NPs directly in the polymeric matrix. EXPERIMENTS The obtained nanomaterials were characterized by transmission electron microscopy (TEM), and Fourier-transformation infrared spectroscopy (FT-IR). NPs loaded into polymers were also investigated using X-ray diffraction (XRD). FINDINGS Based on the results, it was concluded that the amino functionalities simultaneously reduced noble metals ions and capped the NPs. The average diameter of the obtained AuNPs ranged from 25 to 109 nm, while reduction-coupled sorption was carried out in 1 and 3 mol L-1 HCl solutions, respectively. Applying a 0.1 mol L-1 HCl solution containing Au(III), Pd(II) and Pt(VI), a NC with AuNPs and cubic-like PdNPs was fabricated, while using a solution of the same composition, but in 3 mol L-1 HCl, resulted in formation of a NC with flower-like PtNPs. Ultimately, the selected NC based on a resin with functionalities derived from 1-(2-aminoethyl)piperazine and with bi-metallic active sites, i.e. AuNPs and PdNPs, revealed catalytic activity in the reduction of 4-nitrophenol.
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Affiliation(s)
- Piotr Cyganowski
- Wroclaw University of Science and Technology, Faculty of Chemistry, Department of Polymer and Carbonaceous Materials, Wybrzeze St. Wyspianskiego 27, 50-370 Wroclaw, Poland.
| | - Anna Lesniewicz
- Wroclaw University of Science and Technology, Faculty of Chemistry, Department of Analytical Chemistry and Chemical Metallurgy, Wybrzeze St. Wyspianskiego 27, 50-370 Wroclaw, Poland
| | - Anna Dzimitrowicz
- Wroclaw University of Science and Technology, Faculty of Chemistry, Department of Analytical Chemistry and Chemical Metallurgy, Wybrzeze St. Wyspianskiego 27, 50-370 Wroclaw, Poland
| | - Joanna Wolska
- Wroclaw University of Science and Technology, Faculty of Chemistry, Department of Polymer and Carbonaceous Materials, Wybrzeze St. Wyspianskiego 27, 50-370 Wroclaw, Poland
| | - Pawel Pohl
- Wroclaw University of Science and Technology, Faculty of Chemistry, Department of Analytical Chemistry and Chemical Metallurgy, Wybrzeze St. Wyspianskiego 27, 50-370 Wroclaw, Poland
| | - Dorota Jermakowicz-Bartkowiak
- Wroclaw University of Science and Technology, Faculty of Chemistry, Department of Polymer and Carbonaceous Materials, Wybrzeze St. Wyspianskiego 27, 50-370 Wroclaw, Poland
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Silverman JE, Gulati A. An overview of interventional strategies for the management of oncologic pain. Pain Manag 2018; 8:389-403. [PMID: 30320541 DOI: 10.2217/pmt-2018-0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Pain is a ubiquitous part of the cancer experience. Often the presenting symptom of malignancy, pain becomes more prevalent in advanced or metastatic disease and often persists despite curative treatment. Although management of cancer pain improved following publication of the WHO's analgesic ladder, when used in isolation, conservative approaches often fail to control pain and are limited by intolerable side effects. Interventional strategies provide an option for managing cancer pain that remains refractory to pharmacologic therapy. The purpose of this review is to investigate these strategies and discuss the risks and benefits which must be weighed when considering their use. Therapies anticipated to have an increasingly important role in the future of cancer pain management are also discussed.
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Affiliation(s)
- Jonathan E Silverman
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY 100652, USA.,Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY 10065, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY 100652, USA
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Abstract
There are many nonsurgical treatment options for patients with upper limb spasticity. This article presents an algorithmic approach to management, encompassing evidence-based rehabilitation therapies, medications, and promising new orthotic and robotic innovations.
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Affiliation(s)
- Laura Black
- Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 355 East Erie Street, 21st Floor, Suite 2127, Chicago, IL 60601, USA.
| | - Deborah Gaebler-Spira
- Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 355 East Erie Street, Chicago, IL 60601, USA
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Ahmed A, Arora D. Ultrasound-Guided Neurolysis of Six Genicular Nerves for Intractable Pain from Knee Osteoarthritis: A Case Series. Pain Pract 2018; 19:16-26. [PMID: 29761638 DOI: 10.1111/papr.12710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/04/2018] [Accepted: 05/03/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Among the elderly population, chronic osteoarthritis of the knee joint is one of the leading causes of disability and causes considerable pain, joint stiffness, and functional limitations. Although knee replacement is a good option for advanced osteoarthritis, many patients could not undergo surgery due to comorbidities or other reasons. METHODS Four patients with severe pain from grade 3 and 4 osteoarthritis of the knee had undergone ultrasound-guided alcohol neurolysis of the 6 genicular nerves after a positive genicular nerve block with local anesthetics. The demographics, pain intensity (NRS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quality of life (SF-36) were analyzed. RESULTS There was significant improvement in pain intensity at rest, on movement, and on weight bearing after the neurolysis and it has continued for 6 months (P < 0.05). The OKS and WOMAC score had improved from 7.75 ± 1.25 and 77.75 ± 4.34 at baseline, to 20.75 ± 1.70 and 56.25 ± 3.09 at 1 month, and to 18.25 ± 0.95 and 52.00 ± 2.16 at 6 months after the procedure, respectively (P < 0.05). There was also significant improvement in the quality of life after the procedure (P < 0.05). CONCLUSION Ultrasound-guided alcohol neurolysis is a good alternative for patients having severe pain from knee osteoarthritis and provides significant pain relief for more than 6 months.
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Affiliation(s)
- Arif Ahmed
- Asian Institute of Medical Sciences, Faridabad, Haryana, India
| | - Divesh Arora
- Asian Institute of Medical Sciences, Faridabad, Haryana, India
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Lu C, Sun X, Wang C, Wang Y, Peng J. Mechanisms and treatment of painful neuromas. Rev Neurosci 2018; 29:557-566. [DOI: 10.1515/revneuro-2017-0077] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 11/18/2017] [Indexed: 02/01/2023]
Abstract
AbstractA painful neuroma is a common complication of a peripheral nerve injury or amputation, and it can cause tremendous pain that is resistant to most analgesics. Furthermore, painful neuromas have a high postoperative recurrence rate. Painful neuromas are often accompanied by functional disorders, drastically reducing the patient’s quality of life. Several pathophysiological mechanisms have been proposed to explain this type of neuropathic pain, including peripheral and central sensitisation and the involvement of nerve growth factor, α-smooth muscle actin, the cannabinoid CB2 receptor and structural changes in neuroma fibres. Nevertheless, the mechanisms of neuroma-associated pain are not fully understood, contributing to the challenge of managing patients with painful neuromas. There are several effective treatment methods, although none are universally accepted. This review summarises the common mechanisms and treatments of painful neuromas, attempting to link the mechanisms and treatments. We hope to provide useful guidelines for choosing the appropriate treatment for the management of painful neuromas.
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Iatrogenic Phenol Injury Causing Facial Paralysis With Tympanic Membrane and Ossicular Necrosis. Otol Neurotol 2016; 37:385-7. [PMID: 26927759 DOI: 10.1097/mao.0000000000000979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a serious iatrogenic injury and propose means of reducing the risk of its reoccurrence. PATIENTS A 21-year-old man who suffered facial paralysis, complete necrosis of the tympanic membrane, and ossicular discontinuity because of chemical burn from accidental application of copious amounts of topical anesthetic phenol into the ear. INTERVENTIONS Conservative management of facial paralysis and delayed reconstruction of the tympanic membrane and ossicular chain. MAIN OUTCOME MEASURES Gradual recovery to grade 1/6 facial function, successful repair of the tympanic membrane, but persistent 30-dB conductive hearing loss after partial ossicular replacement prosthesis presumably because of scarring. CONCLUSION Phenol is a highly toxic chemical, topically to both skin and eyes. Absorbed through the skin it can have lethal cardiotoxicity. It is also potent neurotoxin at concentrations much lower (4-7%) than used for tympanic membrane anesthesia (89%) and has long been used therapeutically to destroy nerves in patients of contractions or intractable pain. Otologists need to have a healthy respect for the dangers of using phenol. As only a minute quantity is needed for tympanic anesthesia, commercially available prepackaged applicators are preferred. Storage of stock bottles of 89% phenol solutions in clinical settings risks injury to both patients and practitioners.
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Otero-Romero S, Sastre-Garriga J, Comi G, Hartung HP, Soelberg Sørensen P, Thompson AJ, Vermersch P, Gold R, Montalban X. Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper. Mult Scler 2016; 22:1386-1396. [DOI: 10.1177/1352458516643600] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 03/01/2016] [Indexed: 11/16/2022]
Abstract
Background and objectives: Treatment of spasticity poses a major challenge given the complex clinical presentation and variable efficacy and safety profiles of available drugs. We present a systematic review of the pharmacological treatment of spasticity in multiple sclerosis (MS) patients. Methods: Controlled trials and observational studies were identified. Scientific evidence was evaluated according to pre-specified levels of certainty. Results: The evidence supports the use of baclofen, tizanidine and gabapentin as first-line options. Diazepam or dantrolene could be considered if no clinical improvement is seen with the previous drugs. Nabiximols has a positive effect when used as add-on therapy in patients with poor response and/or tolerance to first-line oral treatments. Despite limited evidence, intrathecal baclofen and intrathecal phenol show a positive effect in severe spasticity and suboptimal response to oral drugs. Conclusion: The available studies on spasticity treatment offer some insight to guide clinical practice but are of variable methodological quality. Large, well-designed trials are needed to confirm the effectiveness of antispasticity agents and to produce evidence-based treatment algorithms.
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Affiliation(s)
- Susana Otero-Romero
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d’Hebron University Hospital, Barcelona, Spain/Preventive Medicine and Epidemiology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Giancarlo Comi
- Neurological Department, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Per Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alan J Thompson
- Department of Brain Repair & Rehabilitation, Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Patrick Vermersch
- Université Lille, INSERM, CHU Lille, Lille Inflammation Research International Center (LIRIC) UMR 995, Lille, France
| | - Ralf Gold
- Department of Neurology, Ruhr University, St. Josef-Hospital, Bochum, Germany
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d’Hebron University Hospital, Barcelona, Spain
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Bakheit A, Badwan D, McLellan DL. The effectiveness of chemical neurolysis in the treatment of lower limb muscle spasticity. Clin Rehabil 2016. [DOI: 10.1177/026921559601000108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of phenol and alcohol nerve blocks in the treatment of localized muscle spasticity is well established. However, a number of questions relating to this procedure are still unanswered. This article presents experience of the effectiveness of chemical neurolysis in the treatment of severe lower limb muscle spasticity in 28 patients who had a total of 56 nerve blocks performed during a follow-up period of between four and 18 months.
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Affiliation(s)
- Amo Bakheit
- University Rehabilitation Research Unit, Southampton General Hospital, Southampton
| | - Dah Badwan
- University Rehabilitation Research Unit, Southampton General Hospital, Southampton
| | - DL McLellan
- University Rehabilitation Research Unit, Southampton General Hospital, Southampton
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15
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Kim DD, Asif A, Kataria S. Presentation of Neurolytic Effect of 10% Lidocaine after Perineural Ultrasound Guided Injection of a Canine Sciatic Nerve: A Pilot Study. Korean J Pain 2016; 29:158-63. [PMID: 27413480 PMCID: PMC4942643 DOI: 10.3344/kjp.2016.29.3.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/17/2016] [Accepted: 06/01/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Phenol and alcohol have been used to ablate nerves to treat pain but are not specific for nerves and can damage surrounding soft tissue. Lidocaine at concentrations > 8% injected intrathecal in the animal model has been shown to be neurotoxic. Tests the hypothesis that 10% lidocaine is neurolytic after a peri-neural blockade in an ex vivo experiment on the canine sciatic nerve. METHODS Under ultrasound, one canine sciatic nerve was injected peri-neurally with 10 cc saline and another with 10 cc of 10% lidocaine. After 20 minutes, the sciatic nerve was dissected with gross inspection. A 3 cm segment was excised and preserved in 10% buffered formalin fixative solution. Both samples underwent progressive dehydration and infusion of paraffin after which they were placed on paraffin blocks. The sections were cut at 4 µm and stained with hemoxylin and eosin. Microscopic review was performed by a pathologist from Henry Ford Hospital who was blinded to which experimental group each sample was in. RESULTS The lidocaine injected nerve demonstrated loss of gross architecture on visual inspection while the saline injected nerve did not. No gross changes were seen in the surrounding soft tissue seen in either group. The lidocaine injected sample showed basophilic degeneration with marked cytoplasmic vacuolation in the nerve fibers with separation of individual fibers and endoneurial edema. The saline injected sample showed normal neural tissue. CONCLUSIONS Ten percent lidocaine causes rapid neurolytic changes with ultrasound guided peri-neural injection. The study was limited by only a single nerve being tested with acute exposure.
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Affiliation(s)
- David D Kim
- Department of Anesthesiology, Henry Ford Hospital, Detroit, MI, USA
| | - Asma Asif
- Department of Anesthesiology, Henry Ford Hospital, Detroit, MI, USA
| | - Sandeep Kataria
- Department of Anesthesiology, Henry Ford Hospital, Detroit, MI, USA
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Liu L, Chen X, Liu K, He M, Wang G, Chang X, Fang Y. Formation of An Ionic PTCA-β-CDNH2 Complex and Its Application for Phenol Sensing in Aqueous Phase. ACS APPLIED MATERIALS & INTERFACES 2015; 7:21364-21372. [PMID: 26348064 DOI: 10.1021/acsami.5b06011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
On the basis of proton transfer in aqueous phase, we prepared a water-soluble and highly fluorescent ionic complex of 3,4,9,10-perylene tetracarboxylic acid (PTCA) and 6-deoxy-6-amino-β-CD (β-CDNH2) and studied its fluorescence behavior. It was found that the fluorescence emission of the complex is sensitive and selective to the presence of trace amount of toxic phenolic compounds, in particular phenol, which is crucial for water quality control. The detection limit (DL) of the method to the analyte is ~0.03 μM, a lowest value reported in literatures for similar techniques. Interestingly, the detection at an unprecedented subnanogram (DL, ~0.12 ng/cm(2)) level can also be conducted in a visualized manner, which may provide a simple and low-cost protocol for on-site and real-time detection of the analyte. Moreover, the complex is humidity sensitive in dry state, and its color changes from bright yellow to bright green when exposed to wet vapor. Unlike other PTCA bisimide derivatives, preparation of the ionic complex of PTCA/β-CDNH2 is simple and avoids complicated synthetic burden. Furthermore, introduction of methanol into the aqueous solution of the complex resulted in aggregation as indicated by solution color change and proved by transmission electron microscopy and dynamic light scattering studies, which explains why the compound in dry state is sensitive to the presence of water and water vapor. X-ray diffraction, UV-vis, and fluorescence studies uncovered the H-packing nature of the structure of the aggregate.
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Affiliation(s)
- Lingling Liu
- Key Laboratory of Applied Surface and Colloid Chemistry (Ministry of Education), School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710119, People's Republic of China
| | - Xiangli Chen
- Key Laboratory of Applied Surface and Colloid Chemistry (Ministry of Education), School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710119, People's Republic of China
| | - Kaiqiang Liu
- Key Laboratory of Applied Surface and Colloid Chemistry (Ministry of Education), School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710119, People's Republic of China
| | - Meixia He
- Key Laboratory of Applied Surface and Colloid Chemistry (Ministry of Education), School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710119, People's Republic of China
| | - Gang Wang
- Key Laboratory of Applied Surface and Colloid Chemistry (Ministry of Education), School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710119, People's Republic of China
| | - Xingmao Chang
- Key Laboratory of Applied Surface and Colloid Chemistry (Ministry of Education), School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710119, People's Republic of China
| | - Yu Fang
- Key Laboratory of Applied Surface and Colloid Chemistry (Ministry of Education), School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710119, People's Republic of China
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Ploypetch T, Kwon JY, Armstrong HF, Kim H. A Retrospective Review of Unintended Effects After Single-Event Multi-Level Chemoneurolysis With Botulinum Toxin-A and Phenol in Children With Cerebral Palsy. PM R 2015; 7:1073-1080. [DOI: 10.1016/j.pmrj.2015.05.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 05/18/2015] [Accepted: 05/22/2015] [Indexed: 11/16/2022]
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Ishiwatari H, Hayashi T, Yoshida M, Ono M, Sato T, Miyanishi K, Sato Y, Takimoto R, Kobune M, Masuko H, Miyamoto A, Sonoda T, Kato J. EUS-guided celiac plexus neurolysis by using highly viscous phenol-glycerol as a neurolytic agent (with video). Gastrointest Endosc 2015; 81:479-83. [PMID: 25616759 DOI: 10.1016/j.gie.2014.10.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/23/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Hirotoshi Ishiwatari
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Tsuyoshi Hayashi
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Makoto Yoshida
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Michihiro Ono
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Tsutomu Sato
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Koji Miyanishi
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Yasushi Sato
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Rishu Takimoto
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Masayoshi Kobune
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Hiroyuki Masuko
- Department of Hospital Pharmacy, Sapporo Medical University, Sapporo, Japan
| | - Atsushi Miyamoto
- Department of Hospital Pharmacy, Sapporo Medical University, Sapporo, Japan
| | - Tomoko Sonoda
- Department of Public Health, Sapporo Medical University, Sapporo, Japan
| | - Junji Kato
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
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Lima MRM, Pires W, Fonseca IAT, Fonseca CG, Martinelli PM, Wanner SP, Lima NRV. Chronic sympathectomy of the caudal artery delays cutaneous heat loss during passive heating. Neurosci Lett 2013; 537:11-6. [DOI: 10.1016/j.neulet.2013.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/18/2012] [Accepted: 01/07/2013] [Indexed: 11/28/2022]
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Madanat JP, Geraci S, Jajoo P, Dunn K, Oreste A. Musculoskeletal pain as a novel complication after posterior tibial nerve block in stroke and traumatic brain injury patients. PM R 2011; 3:492-4. [PMID: 21570040 DOI: 10.1016/j.pmrj.2010.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 10/15/2010] [Accepted: 10/19/2010] [Indexed: 11/28/2022]
Affiliation(s)
- John Paul Madanat
- Department of Physical Medicine and Rehabilitation, 825 Northern Blvd, 1st Floor, North Shore-Long Island Jewish Health System, Great Neck, NY 11021, USA.
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21
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Mathis JM, Golovac S, Cho CH. Pharmaceuticals used in image-guided spine interventions. Neuroimaging Clin N Am 2010; 20:215-22. [PMID: 20439017 DOI: 10.1016/j.nic.2010.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
As image-guided (nonvascular) spine interventions have become progressively more common in the interventional radiologic community, there is a growing need for physician expertise regarding the materials and pharmaceuticals that are used for these procedures. This article is intended to provide information to address these needs.
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Affiliation(s)
- John M Mathis
- Centers for Advanced Imaging, Roanoke, VA 24014, USA.
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Akkaya T, Unlu E, Alptekin A, Gumus HI, Umay E, Cakci A. Neurolytic phenol blockade of the obturator nerve for severe adductor spasticity. Acta Anaesthesiol Scand 2010; 54:79-85. [PMID: 19839948 DOI: 10.1111/j.1399-6576.2009.02130.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In this study, we present the 3-month follow-up results of a retrospective analysis of obturator nerve (ON) phenol neurolysis performed between 2000 and 2007 in patients with adductor spasticity. METHODS The study was performed by retrospective investigation of the clinical follow-up results of 80 ON phenol treatments in 62 patients. Neurolysis using 5-10 ml 6% phenol was applied with the guidance of fluoroscopy and a peripheral nerve stimulator. Pain, spasticity and hygiene were evaluated and the hip abduction range of motion (ROM) was measured at the end of the first week and in the first, second and third months following the intervention. RESULTS The visual analogue scale scores decreased significantly in the first week, first month and the second month, but reached their initial values in the third month. A drastic increase in the ROM values was shown in hip abduction in the first week, first month and second month. An increase in the Ashworth Scale values was observed in the second and third months, but they did not reach their initial values. The hygiene score decreased drastically in the first week and the first and second months, but worsened in the third month. The success rate in nerve localization during ON neurolysis was 100%. CONCLUSION ON phenol blockade with fluoroscopy and peripheral nerve stimulator guidance in patients with adductor spasticity 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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Affiliation(s)
- T Akkaya
- Ministry of Health Diskapi Yildirim Beyazit Research and Educational Hospital, Clinic of I. Anaesthesiology-Reanimation & Pain Unit, Ankara, Turkey.
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Evans S, Forester K, Pettiford JM, Morozova O. Increasing physical function through physiatric intervention for children with paediatric neurotransmitter disorders. J Inherit Metab Dis 2009; 32:381-6. [PMID: 19449166 DOI: 10.1007/s10545-009-1190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 03/18/2009] [Accepted: 03/19/2009] [Indexed: 11/30/2022]
Abstract
Most children with paediatric neurotransmitter diseases have global functional deficits secondary to central nervous system damage. Paediatric physiatrists, working in conjunction with a multi-disciplinary team, help to improve physical function by normalizing muscle tone and improving body position. Components of spasticity, rigidity, and dystonia may all need to be considered in a comprehensive treatment programme. Complications of disordered tone include skin breakdown, pain, sleep disturbance, and dysphagia. With an integrated approach to use of medications and equipment as well as implementation of therapy and therapeutic exercise, physiatrists can help maximize functional independence for children with this group of disorders. Pharmacological treatment includes GABA-agonists including baclofen and benzodiazepines, alpha-2 adrenergic agonists, L: -dopa and dopaminergic agents, and dantrolene. Intrathecal baclofen may be used in patients refractory to these medications. In addition, physicians may utilize botulinum toxin, phenol, or surgical interventions such as selective dorsal rhizotomy or tendon lengthening. Pharmacological treatment must be used in conjunction with appropriate adaptive equipment in order to maximize therapeutic benefit. Focus on function in an attempt to increase independence is targeted to improve the child's quality of life. We present a framework and rationale to the management of the functional consequences of the paediatric neurotransmitter diseases.
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Affiliation(s)
- S Evans
- Department of Physiatry, Childrens National Medical Center, The George Washington University School of Medicine, 111 Michigan Avenue, NW, Washington, DC 20010, USA.
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Safety Profile of Multilevel Chemical Denervation Procedures Using Phenol or Botulinum Toxin or Both in a Pediatric Population. Am J Phys Med Rehabil 2008; 87:556-66. [DOI: 10.1097/phm.0b013e31817c115b] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Jain S, Gupta R. Neural Blockade with Neurolytic Agents. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Aydemir O, Yilmaz T, Onal SA, Celiker U, Erol FS. Acute unilateral total visual loss after retrogasserian phenol injection for the treatment of trigeminal neuralgia: a case report. Orbit 2006; 25:23-6. [PMID: 16527771 DOI: 10.1080/01676830500505798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Phenol is a neurolytic agent that is widely used by percutaneous retrogasserian injection in the treatment of trigeminal neuralgia. We report a 78-year-old man who had acute unilateral total visual loss after retrogasserian phenol injection for the treatment of trigeminal neuralgia. The patient's visual acuity, eye movements and the pupillary defect did not improve in the affected eye even after mechanical decompression within 30 minutes and medical treatment, neither in the early period nor during the following two months. The visual loss in this patient seems to result from phenol neurotoxicity rather than mechanical compression of the intraorbital optic nerve. This case demonstrates that although percutaneous retrogasserian phenol injection is a relatively safe and noninvasive method of treatment for trigeminal neuralgia, severe complications may occur.
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Affiliation(s)
- Orhan Aydemir
- Department of Ophthalmology, Firat Medical Center, Firat University, Elazig, Turkey.
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27
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Westerlund T, Vuorinen V, Röyttä M. The perineurium modifies the effects of phenol and glycerol in rat sciatic nerve. Acta Neuropathol 2004; 108:319-31. [PMID: 15300450 DOI: 10.1007/s00401-004-0896-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2004] [Revised: 06/01/2004] [Accepted: 06/01/2004] [Indexed: 10/26/2022]
Abstract
Endoneurial cell response and type of nerve fibre damage were studied after perineural injections of 7% phenol-aqua and pure glycerol. Our previous studies have shown that phenol and glycerol induce different types of nerve fibre degeneration after intraneural injections: phenol dissolves axons and Schwann cells inside the basal lamina tubes but glycerol breaks them down into cellular flakes. The current study investigated whether the difference in type of endoneurial damage also appears after perineural application and how the perineurium affects the effect of these neurolytic agents. Rat sciatic nerves were treated with perineural injections of 7% phenol-aqua or pure glycerol and were followed up to 6 months. The results support the previous findings that perineural phenol injection induces damage that covers almost the whole endoneurium, but glycerol injection results in minor subperineurial damage. An ultrastructural study showed that the endoneurial effects are much milder after perineural injection than after intraneural injections. Phenol-induced nerve fibre dissolving was only rarely seen and the nerve fibre damage appeared similar to that after regular Wallerian degeneration in both groups. Axonal regeneration began within 2 weeks of the injections. Endoneurial macrophages were numerous in the damaged area in many individual nerves even at 3-6 months in both groups, which may indicate impaired phagocytotic activity. Regenerating axonal sprouts were seen first at 1 week post injection and Schwann cells proliferated within 2 weeks in both groups. However, the number of axonal sprouts was higher (P=0.002) and the size of the sprouts appeared larger after glycerol injection at 4 weeks post injection. The present study shows that the effects of extraneurally applied neurolytic agents phenol and glycerol are modified by the perineurium. Phenol readily penetrates the perineurium, but glycerol causes only subperineurial damage. The type of damage is rather similar to regular Wallerian degeneration in both groups and the endoneurial effects differ from those seen after intraneural injections.
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Affiliation(s)
- Taina Westerlund
- Department of Pathology, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
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Gooch JL, Patton CP. Combining botulinum toxin and phenol to manage spasticity in children. Arch Phys Med Rehabil 2004; 85:1121-4. [PMID: 15241761 DOI: 10.1016/j.apmr.2003.09.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the specific techniques and adverse reactions of using concurrent, multiple injections of both botulinum toxin and phenol to manage spasticity in children with cerebral palsy (CP) and other neurologic conditions. DESIGN A retrospective case series. SETTING A tertiary care children's hospital. PARTICIPANTS Consecutive patients (N=68) with spasticity related to CP or other neurologic conditions. INTERVENTION Ninety injection sessions combining botulinum toxin and phenol to manage spasticity. MAIN OUTCOME MEASURE Documentation of adverse reactions. RESULTS The mean phenol dosage was 9.5mL at a mean of 0.6mL/kg per injection dose. The mean botulinum toxin type A (Botox) dose injected was 193U (12U/kg), and the mean of botulinum toxin type B (Myobloc) dose injected was 7750U (530U/kg). The mean number of muscles injected was 14. Adverse reactions are described but were infrequent. Dysesthetic hand pain occurred in 2 patients. One patient developed a systemic reaction to Myobloc. CONCLUSIONS Using botulinum toxin and phenol injections allowed many muscles to be injected to manage spasticity in children with CP and other neurologic conditions. Using this combination allowed an increased number of injections at the maximal recommended dose.
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Affiliation(s)
- Judith L Gooch
- Primary Children's Medical Center, 100 N. Medical Drive, Salt Lake City, UT 84112, USA.
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29
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Candido K, Stevens RA. Intrathecal neurolytic blocks for the relief of cancer pain. Best Pract Res Clin Anaesthesiol 2004; 17:407-28. [PMID: 14529011 DOI: 10.1016/s1521-6896(03)00016-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Intrathecal neurolytic blocks for the treatment of chronic pain were first described by Dogliotti in 1931. Since then, many authors have described the intrathecal injection of various neurolytic substances for the treatment of oncologic pain. In recent years, alcohol and phenol have been the substances most commonly used for this purpose. There are no controlled studies, so the literature consists of observations, reports and book chapters reflecting the opinions of experienced clinicians. This chapter describes the indications, contraindications, potential complications, and expected benefits of intrathecal injection of alcohol and phenol in the treatment of cancer pain. Four cases of cancer patients whose intractable pain was treated by the authors using intrathecal neurolysis are presented. Pertinent literature is reviewed. In this account, the emphasis is on proper selection of patients and techniques.
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Affiliation(s)
- Kenneth Candido
- Northwestern University Medical School, Chicago, IL 60611, USA
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Abstract
The management of cancer pain represents a difficult diagnostic and therapeutic problem for the clinician. In a multidisciplinary approach to the management of cancer pain, neurosurgical methods are an essential part of the therapy. Frequently, patients with advanced cancer suffer from an increasing pain, requesting ever higher dosage of narcotics, and finally seeming to respond only to high dosage of intravenous narcotics. Gradually, the opioids produce less satisfactory analgetics effects an more serious side manifestations. These patients can be considered for surgical management of pain. Historically, surgery for cancer pain began with destructive procedures (neurectomy, rhizotomy, sympathectomy), often referred to as ablative. In past two decades, with the help of the current knowledge of cancer pain mechanisms and some of the technological developments, such as microsurgical and stereotactic techniques, computerized tomography and magnetic resonance imaging, the majority of ablative procedures have been replaced by new methods. Among them a few are selectively and minimally ablative (microsurgical spinothalamic cordotomy, dorsal root entry zone operation, limited midline myelotomy) and the others ones are neuroaugumentative operations ( deep brain structures and spinal cord stimulation, drugdelivery systems).
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Affiliation(s)
- E Slavik
- Institute of Neurosurgery, Clinical Medical Center, Belgrade
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31
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Affiliation(s)
- James F Mooney
- Department of Orthopaedic Surgery, Children's Hospital of Michigan, Detroit, Michigan 48201, USA.
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Jarrett L, Nandi P, Thompson AJ. Managing severe lower limb spasticity in multiple sclerosis: does intrathecal phenol have a role? J Neurol Neurosurg Psychiatry 2002; 73:705-9. [PMID: 12438474 PMCID: PMC1757337 DOI: 10.1136/jnnp.73.6.705] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Established treatment options for managing severe lower limb spasticity and associated pain are of limited value in people with advanced multiple sclerosis (MS). This has resulted in a resurgence of the use of lumbar intrathecal phenol injection (IP). The aim of this study was to investigate the authors' experience with IP. METHODS This observational study collected cross sectional data from patients with progressive MS who received IP for severe lower limb spasticity. Data from 25 patients were collected prospectively before and after treatment. In 15 cases the data related to the first treatment and in 10 to serial injections. Outcome measures collected included the Ashworth scale, a spasm frequency scale, a pain rating score, and the percentage achievement of practical goals. RESULTS After injection, all patients demonstrated reduced lower limb tone bilaterally. After the initial injection there was significant improvement on the targeted as compared with the non-targeted side (Wilcoxon rank p=0.003), while no difference in the degree of improvement between the targeted and non-targeted side was seen after serial injections (Wilcoxon rank p=0.731). Twenty four patients were easier to position and 21 had a reduction in their spasm frequency and intensity. Eleven patients with pain reported benefit. Carers found washing and dressing easier in 16 patients and improved safety when using the hoist in 10. Six patients had recurrence of skin breakdown and five patients reported transient adverse changes in their bowel function. CONCLUSIONS IP can reduce lower limb tone bilaterally after both initial and serial injections. This is most noticeable on the targeted side after initial injection. IP can reduce spasms and pain, leading to improvements in care and overall comfort. IP is an effective treatment option in the management of severe spasticity. Documented selection criteria are essential.
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Affiliation(s)
- L Jarrett
- National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK
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Gordin V, Weaver MA, Hahn MB. Acute and chronic pain management in palliative care. Best Pract Res Clin Obstet Gynaecol 2001; 15:203-34. [PMID: 11358398 DOI: 10.1053/beog.2001.0164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Every palliative care patient should have the expectation that acute and chronic pain management will be an integral part of their overall care. However, in all too many instances, the pain of cancer is often grossly under-treated. This issue is of concern because more than 80% of patients with cancer pain can find adequate relief through the use of simple pharmacological methods. It is even more troubling to note that women and minority groups have their cancer pain under-treated more frequently. Physicians with the basic skills of assessment and treatment will be able to control the symptoms in the majority of cancer pain patients. However, there are still some patients who may require other modalities to control their moderate to severe pain. A thorough understanding of all pain management options will help the gynaecological oncologist to maintain an acceptable quality of life for their patients throughout the therapeutic and palliative phases of care.
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Affiliation(s)
- V Gordin
- Department of Anesthesiology, MC-H187, Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, PO Box 850, Hershey, PA 17033, USA
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Sung DH, Han TR, Park WH, Je Bang H, Kim JM, Chung SH, Woo EJ. Phenol block of peripheral nerve conduction: Titrating for optimum effect. Arch Phys Med Rehabil 2001; 82:671-6. [PMID: 11346846 DOI: 10.1053/apmr.2001.21975] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To verify the dose-response relationship in phenol nerve block and to determine the concentration and volume of phenol injectate required for effective nerve conduction block. DESIGN Before-after, experimental study. SETTING A research institute laboratory. ANIMALS Seventy-one New Zealand white rabbits. INTERVENTIONS Group I (n = 48) received tibial nerve block by perineural injection (phenol, n = 40; saline, n = 8), group II (n = 21) by submerging the nerve in phenol solution. The 6 subgroups of group I each received different concentrations (3%, 4%, 5%) and volumes (0.1mL, 0.2mL, 0.3mL). The 2 subgroups of group II received 3% (n = 8) and 5% (n = 13) phenol. MAIN OUTCOME MEASURES Compound muscle action potential (CMAP) and tension of triceps surae muscles by electric stimulation of the sciatic nerve were measured preintervention and at day 1, and weeks 1, 2, 4, and 8 postblock. Histologic studies were performed on 2 animals from group I. RESULTS Two rabbits in group I died before results were obtained. In the remaining animals, CMAP amplitude reduced significantly (p <.05) as the volume of 5% phenol solution increased from 0.1mL, 0.2mL, to 0.3mL. A high concentration of phenol produced a more pronounced conduction block; however, no significant (p =.0589) difference existed among the 3 concentrations. Submerged tibial nerve had a greater degree of conduction block than perineurally injected nerve. Depth of the degeneration area in nerve fascicle varied with distance from the injection point. CONCLUSIONS The nerve block effect of phenol can be titrated by adjusting the concentration and volume of phenol solution if the technique of application and localization of a block site are standardized.
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Affiliation(s)
- D H Sung
- Department of Physical Medicine and Rehabilitation, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul National University College of Medicine, Korea.
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Gormley ME. Treatment of neuromuscular and musculoskeletal problems in cerebral palsy. PEDIATRIC REHABILITATION 2001; 4:5-16. [PMID: 11330850 DOI: 10.1080/13638490151068393] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Cerebral palsy typically involves a variety of neuromuscular and musculoskeletal problems. These problems include spasticity, dystonia, contractures, abnormal bone growth, poor balance, and loss of selective motor control. These problems can interfere with function and treating them can improve function. The treatments include physical and occupational therapy, bracing, oral medications, neurolytic blocks, neurosurgical procedures, orthopaedic surgery and others. Using a multidisciplinary treatment team with a good understanding of cerebral palsy, the best treatment options can be determined and functional outcomes maximized.
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Abstract
In this study, the injection of phenol into the true vocal fold was evaluated on a rat model as a possible treatment for adductor spasmodic dysphonia. A 10% phenol solution was injected into the right true vocal fold. Quantitative measurement of vocal fold adductory force showed reduction to 35% of the preinjection value 3 months after injection (p < .05). Qualitative evaluation by videolaryngoscopy demonstrated maintenance of the normal vocal fold range of motion. Histologic studies showed a transient inflammatory infiltrate and myolysis, while the vocal fold mucosa and the cricoarytenoid joints remained undamaged. Further investigation into the potential use of phenol for treating spasmodic dysphonia is warranted.
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Affiliation(s)
- T Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, and the Veterans Administration Medical Center, St Louis, Missouri, USA
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Psoas compartment block for the treatment of lower-limb spasticity caused by spinal cord injury: report of a case. J Anesth 1997; 11:300-302. [PMID: 28921070 DOI: 10.1007/bf02480748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/1996] [Accepted: 05/27/1997] [Indexed: 10/24/2022]
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Francisco GE, Ivanhoe CB. Pharmacologic Management of Spasticity in Adults With Brain Injury. Phys Med Rehabil Clin N Am 1997. [DOI: 10.1016/s1047-9651(18)30298-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
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.
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Affiliation(s)
- L A Koman
- Department of Orthopaedic Surgery, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1070, USA
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Bodine-Fowler SC, Allsing S, Botte MJ. Time course of muscle atrophy and recovery following a phenol-induced nerve block. Muscle Nerve 1996; 19:497-504. [PMID: 8622729 DOI: 10.1002/mus.880190404] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Clinically, phenol is used often as a neurolytic agent to treat pain and spasticity. The purpose of this study was to examine the time course of denervation and recovery in several hindlimb muscles following application of a 5% aqueous solution of phenol to the sciatic nerve. Phenol was applied to the sciatic nerve of adult female rats either by intraneural or perineural injection. Axonal degeneration was evident within the sciatic nerve 2 days following phenol application, although variable amounts of damage were observed. By 2 weeks, the soleus and tibialis anterior had atrophied to 63% and 51% of control. Reinnervation of hindlimb muscles occurred between 2 and 4 weeks following the nerve block. Following denervation, the soleus became slower in that all of the fibers expressed the slow myosin heavy chain (MHC). At 5 months, maximum tension of the soleus was 74% of control and the muscle consisted of more fast fibers on average, some of which expressed IIx MHC. These data suggest that 5% phenol causes an injury to the nerve that is more severe than a crush injury, and that reinnervation of denervated muscles may be by motoneurons other than those that originally innervated the muscles.
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Affiliation(s)
- S C Bodine-Fowler
- Department of Orthopedics, UCSD School of Medicine, San Diego, CA, USA
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Tekkök IH, Carter DA, Brinker R. Spinal subdural haematoma as a complication of immediate epidural blood patch. Can J Anaesth 1996; 43:306-9. [PMID: 8829870 DOI: 10.1007/bf03011749] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE The authors report a case of a patient who developed spinal subdural haematoma after a series of epidural blood patches to alert anaesthetists to this rare complication. CLINICAL FEATURES The patient was a 35-yr-old woman without coagulopathy and was initially treated elsewhere for chronic pain by repetitive epidural phenol injections. When the dura was inadvertently punctured during subsequent attempts to inject phenol, immediate epidural blood patch was performed to treat or prevent headache. The patient developed cauda equina syndrome after six epidural blood patches. The clinical diagnosis was confirmed by magnetic resonance imaging and the intradural haematoma was evacuated surgically. The patient made a complete recovery. CONCLUSIONS Epidural blood patch is not without complications. Transient backache and/or radiculopathy may occur in up to one-third of patients receiving a blood patch. If signs and symptoms continue or worsen, a spinal subarachnoid and/or subdural haematoma should be suspected and neurosurgical opinion sought. The technique used to identify the epidural space is important in preventing subdural injection of blood. The needle should be withdrawn after dural puncture and the epidural space identified at a different level. Blood patches may carry a higher risk of serious complications after multiple epidural phenol injections because of fibrosis and obliteration of the epidural space. Magnetic resonance scans reliably demonstrate the extent of the pathology. If diagnosed and treated before irreversible changes occur, spinal intradural haematoma can result in complete recovery.
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Affiliation(s)
- I H Tekkök
- Department of Neurological Surgery, Medical College of Ohio, Toledo, USA
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46
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Abstract
The use of phenol motor nerve blocks is advantageous in the early period of acquired spasticity (ie, that occurring following traumatic brain injury or incomplete spinal cord injury), when increased muscle tone is often the most severe. Because acquired spasticity is dynamic and usually improves slowly, a temporary treatment method used to ameliorate increased muscle tone is desirable. Phenol nerve infiltration provides a temporary motor nerve block that lasts for weeks or months. It allows passive limb mobilization in a comprehensive rehabilitation program that attempts to prevent fixed soft tissue contractures. Permanent or irreversible methods such as operative tendon lengthening, muscle release or recession, or neurectomy are usually best delayed until the spasticity has become static, when the need for surgical correction becomes more firmly indicated, and outcomes of operative intervention are more predictable. Although phenol nerve blocks were initially administered at the spinal cord level to control spasticity, the potential side effects have caused a loss of popularity of this method of administration. The safer and more common use of phenol infiltration at the peripheral nerve level is now more accepted for brain injury and spinal cord injury patients. This report reviews the indications, current concepts, and development of the different methods used to administer phenol nerve blocks. Comparisons to other methods to control spasticity are discussed.
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Affiliation(s)
- M J Botte
- Department of Orthopedic Surgery, University of California, School of Medicine, San Diego, USA
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47
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Zamponi GW, Duff HJ, French RJ, Sheldon RS. Biochemical and biophysical studies of the interaction of class I antiarrhythmic drugs with the cardiac sodium channel. Drug Dev Res 1994. [DOI: 10.1002/ddr.430330310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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48
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Iwatsubo E, Okada E, Takehara T, Tamada K, Akatsu T. Selective intrathecal phenol block to improve activities of daily living in patients with spastic quadriplegia. A preliminary report. PARAPLEGIA 1994; 32:489-92. [PMID: 7970851 DOI: 10.1038/sc.1994.77] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To eliminate severe leg spasms of 15 quadriplegics, 0.3 ml 10% phenol-glycerin was injected into the subarachnoid space at the T12/L1 interspace. The effectiveness for leg spasm was evaluated by the Penn spasticity and Ashworth rigidity scales. Three patients remained completely flaccid; however three had slight, six had moderate and three had complete recurrence of spasms in a follow up period of observation for 1 to 22 (average 13) months. The result of selective intrathecal phenol block was significantly valuable, improving the activities of daily living (ADL) of quadriplegic patients. There were no systemic side effects nor disturbance of bladder, bowel or sexual functions.
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Affiliation(s)
- E Iwatsubo
- Labor Welfare Corporation, Spinal Injuries Center, Fukuoka, Japan
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49
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Abstract
Management of the persistent, acquired, neurogenic equinovarus foot may be a confounding rehabilitative dilemma. Victims of cerebrovascular accidents and traumatic brain injury commonly develop this neurogenic deformity. The plantarflexed and inverted foot position results from an imbalance of forces about the hindfoot due to exaggerated muscle tone and hyperactive stretch reflexes. Significant functional impairment may ensue if a plantigrade foot position cannot be achieved and maintained. Surgical correction may be necessary if conservative measures fail. Determination of the dynamic and static components contributing to the equinovarus deformity is difficult. Gait analysis and dynamic electromyographic studies are valuable adjuncts for operative planning. The wide-ranging goals of surgery vary from improving transfer and ambulation skills, to assisting wheelchair positioning, to facilitating use of braces and/or shoe wear.
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Affiliation(s)
- S J Lawrence
- Department of Orthopaedics, UCSD Medical Center 92103
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50
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Yamada K, Ishihara Y, Saito T. Relief of intractable perineal pain by coccygeal nerve block in anterior sacrococcygeal ligament after surgery for rectal cancer. J Anesth 1994; 8:52-54. [PMID: 28921200 DOI: 10.1007/bf02482755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/1992] [Accepted: 05/07/1993] [Indexed: 10/24/2022]
Abstract
Intractable perineal pain often appears in the anal region following abdominoperineal resection for the treatment of rectal cancer. In such cases, a subarachnoid block or transsacral block is generally used to control pain. However, these procedures sometimes cause complications such as dysuria or sensory paralysis of the pudendum. A new method of pain control is presented herein using absolute alcohol as a neurolytic agent to relieve localized perineal pain through a coccygeal nerve block in the anterior sacrococcygeal ligament. Five cadavers were necropsied to localize the coccygeal nerve. A loop consisting of S4, S5, and Co was found to exist in the space surrounded by the anterior surface of the coccygeal bone and the anterior sacrococcygeal ligament. Absolute alcohol was injected into this space. It is essential that the neurolytic agent remain localized in this space to avoid complications and to successfully block perineal pain. In all patients, we found that this method was extremely effective in blocking localized perineal pain without any complications.
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Affiliation(s)
- Koki Yamada
- Department of Anesthesiology, Nippon Medical School, Tama Nagayama Hospital, 1-7-1 Nagayama, 206, Tama City, Tokyo, Japan
| | - Yukinori Ishihara
- Department of Anesthesiology, Nippon Medical School, Tama Nagayama Hospital, 1-7-1 Nagayama, 206, Tama City, Tokyo, Japan
| | - Toshiyuki Saito
- Department of Anesthesiology, Nippon Medical School, Tama Nagayama Hospital, 1-7-1 Nagayama, 206, Tama City, Tokyo, Japan
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