The short-term effect of ultrasound and peripheral nerve stimulator-guided femoral nerve block with phenol on the outcomes of patients with traumatic spinal cord injury

Demir, Yasin; Şan, Ayça Uran; Kesikburun, Serdar; Yaşar, Evren; Yılmaz, Bilge

doi:10.1038/s41393-018-0142-7

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…Subsequently, Demir et al have shared their experiences with phenol neurolysis to femoral nerve branches localized by ultrasound guidance and EStim in 19 persons with SCI. 12 They report successful outcomes with no reported dysesthesias. 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.…”

Section: Discussionmentioning

confidence: 97%

“…Subsequently, Demir et al have shared their experiences with phenol neurolysis to femoral nerve branches localized by ultrasound guidance and EStim in 19 persons with SCI . They report successful outcomes with no reported dysesthesias.…”

Section: Discussionmentioning

confidence: 99%

“…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: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%