When are neurolytic blocks indicated for pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Answer

Neuraxial neurolytic blocks are advocated to alleviate severe intractable pain caused primarily by advanced terminal cancer. The use of these techniques for chronic, nonmalignant pain should be discouraged. Agents used for this purpose include ethyl alcohol, phenol in glycerin, chlorocresol in glycerin, aqueous phenol, hypertonic saline solution, and ammonium compounds.

Subarachnoid neurolytic block is used to relieve severe pain resulting from continuous nociceptive impulses from skin, subcutaneous tissue, deep somatic structures, and viscera. Neurolytic agents are aimed by positioning the patient depending on whether the destructive agent is hyperbaric or hypobaric, so that the axons of the posterior rootlets are destroyed upon contact, thereby affecting neural input from the dorsal root ganglion to the spinal cord.

Subarachnoid neurolysis also can be used effectively for managing patients with spasticity. Intrathecal neurolysis is not associated with significant pain and causes few serious complications; therefore, it can be performed on patients who are in poor physical condition and on elderly patients. Only a brief hospital stay may be necessary; therefore, it is more available to patients than other techniques because it requires no special costly or highly sophisticated equipment or facilities. Neurolytic injections can be repeated or extended if pain spreads or persists. Subarachnoid neurolytic block can delay or avoid neurosurgical procedures, and the duration of pain relief is usually sufficient to afford adequate comfort for patients with terminal cancer.


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