CT Scan guided interscalene brachial plexus neurolysis using 95% alcohol in a patient with Neurogenic Thoracic Outlet Syndrome: A case report

@#A number of patients with thoracic outlet syndrome experience intractable pain unresponsive to pharmacologic treatment. In this case, a brachia! plexus neurolysis was performed to address the patient's pain secondary to an enlarging left supraclavicular node. Guided under CT scan, 3 ml of 95% alcohol was injected in between the anterior and middle scalene muscles onto the trunks of the left brachia! plexus, affording immediate pain relief. Particular concerns of motor blockade, phrenic nerve palsy, stellate ganglion blockade, and bleeding did not occur. Therefore, brachia! plexus neurolysis can be safely done at a lower volume, without the above debilitating complications. It can be an option in relieving intractable upper extremity pain.

Sonographically Guided Alcohol Injection in Painful Stump Neuroma

Stump neuroma is a common cause of pain from disorganized proliferation of nerve fascicles occurring after limb amputation. Ultrasound guided alcohol injection in painful stump neuroma has been tried as a new treatment approach. Herein, we report 2 male patients, who had traumatic amputation and claimed severe and diffuse burning pain in the stump area. Neuroma at the distal end of an amputated nerve was clearly identified on sonography. The patients gradually developed increasing severe pain that could not be managed with conservative care. They were treated with neurolysis using alcohol solution. Using ultrasonographical guidance, 1.2 ml of 100% dehydrated alcohol was injected into the nerves proximal to neuroma. No complications occurred. The patients were initially pain free. After a few months, however, their stump pain recurred slightly. Repeat neurolysis was performed using 0.3 ml of 100% dehydrated alcohol. During the three months follow-up period, mild stump pain occurred but the patients did not require any analgesics.

The Changes after Alcohol Neurolysis of the Tibial Nerve Motor Branches to Gastrocnemius Muscles in Poststroke Patients

OBJECTIVE: To evaluate the effectiveness and electrophysiological changes after alcohol neurolysis of the tibial nerve motor branches to gastrocnemius muscles on the treatment of ankle spasticity in stroke patients. METHOD: Fourteen poststroke hemiplegic patients who had an abnormal gait pattern due to the ankle spasticity participated. They were evaluated by modified Ashworth scale (MAS) score, passive range of motion (PROM) of ankle, and ankle clonus, and were studied using electrophysiological measurements such as amplitude and latency of H-reflex and M response, and H/M ratio. 50% alcohol was injected into the tibial nerve motor branches to the both gastrocnemius muscles with electromyography guidance. Follow-up evaluations were performed immediately, and then, at the one-week, one-month, and three-months following the neurolysis. RESULTS: The MAS scores significantly decreased and the PROM of the ankle significantly increased. The M response and H-reflex amplitude of gastrocnemius muscles significantly decreased after the neurolysis and they had a tendency to increase at the 3-months follow-up. Also, H/M ratio significantly decreased. There were no serious postinjection complications. CONCLUSION: Alcohol neurolysis of the tibial nerve motor branches was an effective and safe method for the treatment of the ankle spasticity in poststroke hemiplegic patients.