Phenol Neurolysis for Severe Chronic Nonmalignant Pain: Is the Old also Obsolete?

Abstract

The use of phenol 4% in aqueous solution is an effective and safe technique for neurolysis. Because of the potential risk of flaccid paralysis, this technique should be used in selected cases, far removed from motor nerves and the spinal cord.

Chronic Female Pelvic Pain—Part 2: Differential Diagnosis and Management

“…Overall, patients had significant pain relief, improved activities of daily living, and decrease use in narcotics. 172 However, as Weskler mentioned, there is a potential risk of flaccid paralysis, and they recommended this technique be reserved for cases far removed from motor nerves and the spinal cord.…”

Flank hernia secondary to phenol nerve block

“…The use of phenol for neurolysis is not without risks [3]. There are no reports in the literature to date of flank hernias secondary to phenol injection.…”

“…While perineural block with aqueous phenol of concentrations less than 2% provide local anaesthesia with no significant nerve destruction, concentrations above 3% (6% in this case) denature proteins and cause nerve destruction with axonal degeneration [1]. The ideal concentration of phenol for neurolytic treatment is not well determined and varies between 3 and 12% [3].…”

“…As two subsequent peripheral nerve blockades with 0.5% of marcaine provided minimal relief, chemical neurolysis with 6% Phenol was attempted. The American Society of Anaesthesiologists Task Force on Pain Management recommends the use of chemical (phenol or alcohol) or thermal (radiofrequency or cryoneurolysis) neurolysis if other techniques have failed to provide adequate pain control [3,4]. While perineural block with aqueous phenol of concentrations less than 2% provide local anaesthesia with no significant nerve destruction, concentrations above 3% (6% in this case) denature proteins and cause nerve destruction with axonal degeneration [1].…”

Percutaneous Upper Thoracic Radiofrequency Sympathectomy in Raynaud Phenomenon

“…Complications related to phenol are not trivial; they may include chemical neuritis, flacid paralysis if injected close to the motor nerves, and also some systemic complications. 25,26 Radiofrequency interruption of upper thoracic sympathetic structures was developed for better control of the size of the lesion. The first series of patients was reported by Wilkinson 10 who performed RF-TSE on 110 patients.…”