Table 28 Phenol Neurolysis for Reducing Spasticity

Author Year

Country
Research Design

Score
Total Sample Size

Methods Outcome

 Demir et al. 2018

Turkey

Pre-Post

N=19

 

Population: SCI (n=19): Mean age=33±9.4yr; Gender: males=11, females=3; Level of injury: C=8, T=6; Mean time since injury=90.7±104.5mo; AIS scale: A=6, B=5, C=2, D=1.

Intervention: All participants received 19 ultra sound-guided femoral nerve block. Femoral neurolysis was performed with a peripheral nerve stimulator with a frequency of 1 Hz for 0.1 ms. Initial intensity was 3 mA. Three mL of 5% phenol was administered to the perineural area after stimulation. Outcome measures were assessed at baseline, end of the 1st week, and at the end of the second month.

Outcome Measures: modified Ashworth Scale; frequency of spasms; satisfaction.

1.     There were significant decreases in mAS scores of hip flexor muscle tone at 1st week and 2nd month follow-up assessments when compared to baseline (p<0.017).

2.     There was were significant decreases in spasticity in the mAS score of knee extensor tone at end of 1st week and 2nd month when compared to baseline (p<0.017).

3.     There were significant increases in participant satisfaction regarding treatment at 1st week and 2 month follow-ups when compared to baseline. Moreover, satisfaction improved significantly from 1st week to 2nd month follow-up (p<0.017).

 

Ghai et al. 2013

India

Pre-Post

N=20

Population: Mean age: 36.7 yr; Gender: males=17, females=3; Injury etiology: SCI=16, koch’s spine=2, MS=2.

Intervention: 10 ml of 0.25% bupivacaine. If 1° MAS decrease and 20° range of motion increase were observed, obturator nerve blockade with 8-10 ml of 6% phenol was performed using the interadductor approach the next day. Outcomes were assessed at the 1st hr, 24th hr, end of 1st wk, and 1st, 2nd, and 3rd mo post treatment.

Outcome Measures: Modified Ashworth Scale (MAS), Visual Analog Scale (VAS), Spasm Frequency Scale (SFS), Range of Motion (ROM), Hygiene score, Gait scale score.

1.      All parameters with the exception of gait significantly improved (p<0.05) compared with the baseline during all time periods between 1 hr and 3 mo post treatment.

2.      Gait score showed significant improvement (p<0.05) compared with the baseline between 1 wk and 3 mo post treatment. There was no significant improvement in gait score before 1 wk.

3.      Adverse events: 2 participants developed dysesthesia lasting for 7 to 10 days; 1 participant developed fibrosis at the injection 20 days post-injection; no participants developed neuritis or secondary deafferentation pain

Ghai et al. 2012

India

Case Series

N=3

Population: Mean age: 18.3 yr; Gender: males=3, females=0; Level of injury: T4-6=2, C4-5=1; Level of severity: AIS D=3.

Intervention: 8-10 ml 65% alcohol to obturator nerves with interadductor approach after successful 10 ml of 0.5% bupivacaine block.

Outcome Measures: ROM, Pain Visual Analog Scale (VAS), Modified Ashworth Scale (MAS), Hygiene. Outcomes assessed at 1 wk, 3 mo and 4 mo post injection.

 

1 wk post-injection:
Case 1:
“Drastic” improvements in hip joint ROM, pain VAS, MAS, hygiene
Duration of improvements: 3 mo for ROM, MAS, hygiene; 4 mo for pain VAS
Case 2: “There was significant improvement in pain,
spasticity, range of motion of hip joint, hygiene scores, and number of muscle spasms. It has been 6mo now, and the effect of alcohol is still persisting”
Case 3:
“Though the VAS score decreased significantly but spasticity and numbers of spasms were not much alleviated, and the participant was quite unsatisfied with the block”

Yasar et al. 2010

Turkey

Retrospective Case Series

N=20

Population: Mean age: 42.9 yr; Gender: males=19, females=1; Injury etiology: traumatic, non-traumatic SCI; Level of injury: tetraplegia=3, paraplegia=17; Level of severity: AIS A=13, AIS B=7; Mean time since injury: 41.8 mo.

Intervention: Phenol obturator nerve blockade.

Outcome Measures: Hip adductor spasticity.

1.     Mean hip adductor spasticity decreased significantly after (p<0.001).

 

Uchikawa et al. 2009

Japan

Case Series

N=7

Population: Mean age: 55.8 yr; Gender: males=7, females=0; Injury etiology: SCI=7; Level of injury: C5=5; Time since injury: ≥5 mo.

Intervention: Subscapular phenol nerve block.

Outcome Measures: Shoulder Range of Motion (ROM), Visual Analog Scale (VAS) for pain, Ashworth Scale (AS), Eating functional independence measure item score.

1.     Significant improvements in passive ROM in flexion (23.71), abduction (19.41) and external rotation (16.81; p<0.05)

2.     Decreases in the VAS for shoulder pain which was reduced from 6.0 to 3.4 (p<0.05).

3.     No significant change in the MAS for shoulder spasticity.

4.     Eating Functional Independence Measure item score improved significantly (p<0.05).

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