Subarachnoid and Other Clinical Uses of Phenol

Abstract

“Be the destiny of observation what it may it has seemed to me on the whole to be worth recording” noted Leonard Corning in 1885 after having injected cocaine intrathecally. Subscribing to the widely held theory of the time that a drug would act only if absorbed through blood vessels, he injected cocaine in the vicinity of the vascular leash supplying the spinal cord. The exact site of the action of the drug is open to dispute, but although the extradural space has been cited, it seems more probable in view of the small quantity of cocaine used that an accidental spinal had been performed. After Dogliotti [1] injected alcohol intrathecally in 1931 similar reports followed, but a high incidence of complications prevented universal acceptance. Maher [2] introduced intrathecal phenol in 1955, claiming it was easier to manage than alcohol and had more predictable results. Since that time, subarachnoid phenol and chlorocresol have become the two most commonly used neurolytic agents in the management of cancer pain.