What are the disadvantages and complications of 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

Intrathecal neurolysis for the management of cancer pain is not, however, devoid of problems and disadvantages. Inadequate pain relief may result from failure of the injection to interrupt all nociceptive pathways completely or from spread of the pain beyond the anesthetized region following the injection. Although the block initially may interrupt nerves to the painful region and afford relief of the pain, aggressive neoplasms often spread beyond the confines of induced analgesia to cause additional symptoms. Fortunately, the block can be repeated several times without further taxing the patient's already overburdened physiological status.

Complications may occur during or following the procedure, such as muscle weakness affecting the limbs or rectal and bladder sphincters. Contraindications for subarachnoid neurolysis include pain that is diffuse or poorly localized; tumor infiltration with involvement of the spinal cord or vertebral column at the level of injection; and inadequate pain relief despite repeated LA test blocks. Epidural and subdural neurolytic blockade also can be used with similar techniques as mentioned above and for similar indications.


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