TY  - CHAP
M1  - Book, Section
TI  - Neurolytic Blocks
A1  - Candido, Kenneth D.
A1  - Knezevic, Nebojsa Nick
A2  - Diwan, Sudhir
A2  - Staats, Peter S.
Y1  - 2015
N1  - 
T2  - Atlas of Pain Medicine Procedures
AB  - Dogliotti1  first  described  the  technique  of  subarachnoid  chemical  neurolysis  using  alcohol  for  the  treatment  of  sciatic  pain  more  than  80  years  ago.  That  same  year,  Suvansa2  described  intrathecal  carbolic  acid  for  the  treatment  of  tetanus.  A  quarter  of  a  century  later,  Maher3,4  in  his  2  landmark  articles  described  his  experience  with  hyperbaric  phenol  and  silver  nitrate  for  subarachnoid  neurolysis,  stating,  “It  is  easier  to  lay  a  carpet  than  to  paper  a  ceiling,”  an  obvious  reference  to  his  understanding  of  the  baricity  properties  of  alcohol  and  phenol  (carbolic  acid).  Over  the  ensuing  years,  however,  lack  of  experience  with  either  technique  and  fear  of  the  anticipated  complications  resulted  in  underuse  of  this  neurolysis,  especially  when  applied  to  the  subarachnoid  space.  Better  understanding  and  increased  use  of  neuraxial  opiates  for  cancer  pain  since  the  1980s  have  decreased  the  use  of  subarachnoid  chemical  neurolysis  even  further.  Nonetheless,  because  of  the  physical  separation  of  the  sensory  and  motor  roots  of  spinal  nerves  within  the  spinal  canal,  intrathecal  dorsal  rhizotomy  (more  appropriately  called  rhizolysis)  is  the  only  neurolytic  procedure  that  allows  sensory  block  without  concomitant  motor  block.  Because  of  this  and  because  of  the  relative  precision  with  which  the  affected  nerve  roots  can  be  blocked,  the  technique  is  particularly  useful  for  treating  cancer  pain  in  an  extremity,  where  preservation  of  motor  function  is  so  important.  In  short,  the  physical  separation  of  motor  and  sensory  fibers  in  the  subarachnoid  space  preserves  forever  a  small  but  unique  role  for  subarachnoid  neurolysis  in  the  management  of  cancer  pain  in  carefully  selected  patients.  The  present  chapter  will  describe  the  techniques  of:  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1107200848
ER  -