Neurolytic Blocks

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton and Khloud Shreif  

Introduction

Neurolytic blocks (nerve blocks) are a medical procedure involving the targeted destruction of a nerve or nerve plexus (group of nerves) to relieve chronic pain or spasticity. The procedure can be performed using various techniques, including chemical neurolysis, radiofrequency ablation (RFA), cryoablation, and neurosurgical procedures.

Neurolytic Block Techniques

1. Chemical neurolysis: the injection of a neurolytic agent, such as alcohol or phenol, into the targeted nerve. This causes damage to the nerve and can provide relief from pain for several weeks or months.
2. Radiofrequency ablation (RFA): the use of heat to damage the nerve and relieve pain. This procedure is often used to treat pain in the facet joints, sacroiliac joints, and intervertebral disks.
3. Cryoablation: the use of extreme cold to damage the nerve and relieve pain. This procedure is often used to treat pain in cancer patients.
4. Neurosurgical procedures, such as neurectomy: the surgical removal of a nerve to relieve pain. This procedure is often used as a last resort when other treatments have failed.

Radiofrequency ablation often provides temporary relief from back pain, unfortunately the relief typically lasts for three to six months and then comes back. Watch this 2 minute video learn more.

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Indications

1. Diagnostic nerve blocks: to locate the source of pain.
2. Anesthetic nerve blocks: often nerve blocks are performed before surgeries to help manage pain after the procedure. They use this in addition to general anesthesia for complex surgeries.
3. Therapeutic nerve blocks

Indications for therapeutic neurolytic blocks include chronic pain resistant to other treatments ( eg. pharmacologic, physical, and non-destructive interventional therapy). Treatment strategies for neuralgia should start with pharmacotherapy, however these often do not obtain effective results and results in a reduction of the patients quality of life. It is often necessary to resort to non-pharmacological strategies such as neurolytic blocks. Peripheral neurolytic blocks are indicated to alleviate severe intractable pain.The following conditions may be treated this way:

1. Facetogenic and vertebral pain
2. Trigeminal neuropathy
3. Visceral pain originating from upper abdominal malignancy, especially pancreatic cancer
4. Pelvic visceral pain
5. Intercostal nerve pain
6. Sympathetic plexus pain
7. Peripheral nerve blockade is one of the therapeutic possibilities to treat spasticity of various muscles in the following conditions: Cerebral palsy; Stroke; Spinal cord injury; Multiple sclerosis; Traumatic brain injury.

Contraindications

Include:

• Active infection at the site of injection
• Allergy to a chemical neurolytic agent
• Bleeding disorders or anticoagulation treatment
• Pacemaker in place (if RFA is planned)
• Client not willing

Complications

These include:

• Bleeding
• Infection
• Pain
• Damage to surrounding tissue
• Intravascular injection of a neurolytic agent
• Superficial cryoablation may lead to skin damage
• Neuritis may occur after partial denervation with a neurolytic agent
• Prolonged motor paralysis may result if neurolysis of a motor nerve occurs
• Bowel, bladder, and sexual dysfunction may result from denervation.

Outcomes

• Results of therapeutic neurolytic blocks vary depending on which technique was used and patient population. Studies have shown varying results, some showing neurolytic blocks can provide significant relief from pain, while others have shown mixed results. The procedure should only cautiously considered only after a failure of other modalities, including pharmacologic, physical, psychiatric, and non-destructive interventional therapy.
• A recent study showed outcomes of selective nerve root blocks for Acute Lumbar Disc Herniation (LDH) was an effective technique to provide consistent symptom relief at least till 1 year in patients with acute LDH.
• Peripheral Nerve Blocks for Diagnosis of Migraine Trigger Points: Peripheral nerve blocks are a reliable clinical tool in mapping migraine trigger sites for surgical intervention, giving more flexibility in their administration and recording as compared to established diagnostic methods.
• The authors of a cochrane review concluded peripheral nerve blocks improve patients’ outcomes in Adults With Hip Fracture. They reduce pain on movement within 30 mins after block placement and risk of acute confusional state and probably also reduce the risk of chest infection and time to first mobilization.