Skip to main content
Log in

Do neurolytic blocks have a role in chronic nonmalignant pain?

  • Published:
Current Review of Pain Aims and scope Submit manuscript

Abstract

Neurolytic blockade and neural blockade in general have come under scrutiny as the evidence-based medicine revolution moves forward. Prognostic nerve blocks with local anesthetic have been shown to correlate poorly with relief of chronic pain following nerve resection [1]. Numerous reasons exist to explain the discrepancy [2]. The purpose of this chapter is to describe the role of neurolytic blocks in clinical practice, making the point that the trend is shifting away from neurolytic solutions toward more controlled techniques. Factors producing the shift away from neurolytic solutions include 1) long-term follow-up information, 2) incidence and severity of complications, and 3) improved alternative treatments, including chronic opioid therapy and neuroaugmentation techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Noordenbos W, Wall PD: Implications of the failure of nerve resection and graft to cure chronic pain produced by nerve lesions. J Neurol Neurosurg Psychiatry 1981, 44:1068–1073.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Hogan Q, Abram S: Neural blockade for diagnosis and prognosis: a review. Anesthesiology 1997, 86:216–241. This article concludes that there are many limitations that weaken the theoretic basis for neural blockade as a diagnostic or prognostic tool.

    Article  CAS  PubMed  Google Scholar 

  3. Slappendel R, Crul B, Braak G, et al.: The efficacy of radiofrequency lesioning of the cervical spinal dorsal root ganglion in a double blinded randomized study: no difference between 40°C and 67°C treatments. Pain 1997, 73:159–163.

    Article  CAS  PubMed  Google Scholar 

  4. Conig HM, Koster HT, Niemeyer RPE: Spinal cord lesion following percutaneous radiofrequency spinal rhizotomy. Pain 1991, 45:161–166.

    Article  Google Scholar 

  5. Lord SM, Barnsley L, Wallis V, et al.: Percutaneous radiofrequency for chronic cervical zygapophyseal joint pain. N Engl J Med 1996, 335:1721–1726.

    Article  CAS  PubMed  Google Scholar 

  6. Polati E, Finco G, Gottin L, et al.: Prospective randomized double blind trial of neurolytic celiac plexus block for patients with pancreatic cancer. Br J Surg 1998, 85:199–200.

    Article  CAS  PubMed  Google Scholar 

  7. Galizi E, Lahni S: Paraplegia following celiac plexus block with phenol. Br J Anaesth 1974, 46:539.

    Article  Google Scholar 

  8. Lloyd G, Bullingham R, et al.: Post operative analgesia for day case herniorhaphy patients: in comparison of cryoanalgesic, paravertebral block and or analgesia. Anaesthesiology 1981, 36:603–610.

    Google Scholar 

  9. Gough JD, Willliams AB, Vaughan RS: The control of post thoracotomy pain: a compared evaluation of thoracic epidural fentanyl infusions and cryoanalgesia. Anaesthesiology 1998, 43:780–783. In this randomized double-blind study the efficacy of neurolytic coeliac plexus block was compared with pharmacologic therapy in the treatment of pain from pancreatic cancer.

    Google Scholar 

  10. Haynsworth RF, Noe CE: Percutaneous lumbar sympathectomy: a comparison of radiofrequency denervation versus phenol neurolysis. Anesthesiology 1991, 74:459–463.

    Article  PubMed  Google Scholar 

  11. Noe CE, Haynsworth RF: Lumbar radiofrequency sympatholysis. J Vasc Surg 1993, 17:801–806.

    Article  CAS  PubMed  Google Scholar 

  12. Wilkinson HA: Percutaneous radiofrequency upper thoracic sympathectomy. Neurosurgery 1996, 38:715–725.

    Article  CAS  PubMed  Google Scholar 

  13. Curley J, Costillo J, Hotz J, et al.: Prolonged regional blockade. Injectable biodegradable bupivacaine/polyester microspheres. Anesthesiology 1996, 84:1401–1410.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Racz, G., Heavner, J.E. & Noe, C.E. Do neurolytic blocks have a role in chronic nonmalignant pain?. Current Review of Pain 2, 181–186 (1998). https://doi.org/10.1007/s11916-998-0017-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-998-0017-2

Keywords

Navigation