Neurolytic nerve block

When systemic or topical pharmacotherapy and other non-invasive approaches provide inadequate relief in patients with NP, interventional approaches may be used, including sympathetic blockade with local anesthetics, intraspinal drug delivery, spinal cord stimulation, peripheral subcutaneous nerve stimulation, or stimulation of specific central nervous system structures, and various neuroablative procedures (e.g. dorsal rhizotomy, neurolytic nerve block, intracranial lesioning). Neuroablative procedures are not reversible and should be reserved for carefully and properly selected patients with intractable pain. 

Peripheral nerve block is created by injecting ethanol around the selected nerve. The effect of alcohol on nerve tissue has been examined in animal models and in postmortem specimens from patients who received neurolytic blocks (8,9). In general, alcohol causes destruction of nerve fibers, with subsequent Wallerian degeneration. The basal lamina around the Schwann cell usually remains intact. This leaves a tract available for axon regeneration without the formation of a neuroma. If the cell bodies are completely destroyed, regeneration will not occur. Contact of alcohol with unintended nerve roots underlies many of the more serious complications. Involvement of anterior rootlets sufficient to interrupt motor nerve function will result in muscle weakness or paralysis. Interruption of... 

Phenol is neurolytic it makes the skin less sensitive for several days, and it is possible to touch up certain areas without causing any real pain after the nerve block anesthesia has worn off, even the day after the peel. Even if deep inflammatory phenomena make the dermis painful, the epidermis remains insensitive. 

Modalities of Cancer Pain Therapy 233 Interventional Computed Tomography Techniques in Cancer Pain Management 234 Regional Analgesia with Neurolytic Block 234 Neurolytic Block of Spinal Nerve 234 Sympathetic Chain Block 236 Management of Pain Syndromes Associated with Direct Tumor Involvement 242 Percutaneous Cementoplasty ... 

The applications of computer tomography (CT)-guided interventions range from precise neurolytic block (neurolysis) of somatic spinal nerves and neurolytic sympathetic blockade to tumor alcoholization and percutaneous cementoplasty (Kanpolat et al. 1990 Gangi et al. 1994a Quinn et al. 1988). 

Regional analgesia with neurolytic blocks (neurolysis) achieved by injection of alcohol or phenol involves the intentional destruction of a nerve or nerves to interrupt nociceptive pathways for weeks or months (Ferrer-Brechner 1989 Filshie 1988 Lipton 1989 Oran 2001). It is essential to inform the patient of the details, the benefits, and any side effects that might occur with the block technique. 

Neurolytic block achieved by injecting 3-5 ml of 96% ethanol into or adjacent to one or more nerve trunks might be necessary in patients with severe excruciating pain who are not amenable to narcotics. 

After neurolytic block of spinal nerves, pain relief lasts for only a few months, after which chemical neuropathy consequent to the injection of a neurolytic agent produces severe pain. This technique should be reserved only for patients with far-advanced or nearterminal cancer. Neurolytic block of somatic nerves should only be used in patients with severe terminal cancer pain not amenable to any other procedure. 

The largest experience to date with neurolytic thoracic and lumbar sympathetic block is in the treatment of occlusive vascular disease (Schild 1998). After sympathetic block, assessment of completeness of the interruption is best done by determining loss of sweat and a rise in skin temperature. This technique can however give rehef to patients with intractable pain caused by carcinoma, in whom conventional therapy is no longer effective (Bonica 1990b). Possible complications with thoracic sympathetic blocks include accidental puncture of the lung, puncture of intercostal vessels, or contact with the thoracic somatic nerve if the bevel... 

Neurolytic Block of the Celiac Plexus and Splanchnic Nerves... 

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