Optimal Effect of Phenol Block in the Sciatic Nerve of Rats: Standardization of Minimized Dosage and Duration of Application

10.4077/CJP.2015.BAD299

Chuan-Chao Lin；Chein-Wei Chang；Su-Ju Tsai

nerve block ； nerve stimulation ； neurolysis ； phenol ； rehabilitation ； spasticity

The Chinese Journal of Physiology

58卷4期（2015 / 08 / 01）

237 - 243

英文

The phenol nerve block has been widely used in clinical practice for spasticity reduction, but the correlation between the dosage of phenol and its effectiveness has seldom been discussed. The objective was to determine the optimal duration of phenol in contact with the nervous tissue and to investigate the dose-response relationship of 5% aqueous phenol solution by percutaneous nerve block in rats. Group I (n=8) received sciatic nerve block by bathing the nerves in phenol solution, and group II (n=40) by injecting phenol percutaneously. Group IIa to IId received different volumes (0.80, 0.16, 0.08 and 0.04ml) and group IIe received normal saline. Compound muscle action potential (CMAP) was measured pre-injection and at 90 and 270 sec after injection and after surgical exposure of the nerves. The duration of CMAP reduced by 10%, 25%, 50%, 75% and 100% after phenol injection was also recorded. The mean latency for the evoked response to subside in direct phenol application (group I) and percutaneous nerve block (group IIa) were 73.5±5.9 and 62.4±7.6sec, respectively. There was no statistical difference for the time periods in the blocking effect elicited by phenol solution between these two methods. Ninety sec was set as the optimal duration for phenol to produce complete conduction blockage. Higher volume of phenol produced more significant blocking effect at 90 and 270 sec after injection. Percutaneous injection with 0.16 ml of phenol solution had the same blocking effect as 0.8ml. The continuous injection model for percutaneous phenol block indeed used significantly more phenol than actually needed. Clinically, the progressive injection model can be used to minimize injection volume.

1. Chang, Y.J.,Huang, W.J.,Lin, H.W.,Chang, L.L.,Chang, F.Y.,Wang, P.S.(2011).A radioimmunoassay for rat ghrelin: evaluation of method and effects of nonylphenol on ghrelin secretion in forcefed young rats.Chinese J. Physiol.,54,324-331.
   連結：
2. Beckerman, H.,Lankhorse, G.J.,Verbeek, A.L.,Becher, J.(1996).The effects of phenol nerve and muscle blocks in treating spasticity: review of the literature.Crit. Rev. Phys. Rehabil. Med.,8,111-124.
3. Bell, K.R.(1995).The use of neurolytic blocks for the management of spasticity.Phys. Med. Rehabil. Clin. N. Am.,6,885-895.
4. Botte, M.J.,Abrams, R.A.,Bodine-Fowler, S.C.(1995).Treatment of acquired muscle spasticity using phenol peripheral nerve blocks.Orthopedics,18,151-159.
5. Braddom, R.L.(ed.)(2000).Physical Medicine and Rehabilitation.Philadelphia, PA:WB Saunders Company.
6. Felsenthal, G.(1974).Pharmacology of phenol in peripheral nerve blocks: a review.Arch. Phys. Med. Rehabil.,55,13-16.
7. Gooch, J.L.,Patton, C.P.(2004).Combining botulinum toxin and phenol to manage spasticity in children.Arch. Phys. Med. Rehabil.,85,1121-1124.
8. Gracies, J.M.,Elovic, E.,McGuire, J.,Simpson, D.M.(1997).Traditional pharmacological treatments for spasticity. Part I: local treatments.Muscle Nerve,6(Suppl),S61-S91.
9. Kottke, F.J.(ed.),Lehman, J.F.(ed.)(1990).Krusen's Handbook of Physical Medicine and Rehabilitation.Philadelphia, PA:WB Saunders Company.
10. Mooney, V.,Frykman, G.,McLamb, J.(1969).Current status of intraneural phenol injections.Clin. Orthop.,63,122-131.
11. Pandyan, A.D.,Gregoric, M.,Barnes, M.P.,Wood, D.,Van Wijck, F.,Burridge, J.,Hermens, H.,Johnson, G.R.(2005).Spasticity: clinical perceptions, neurological realities and meaningful measurement.Disabil Rehabil.,27,2-6.
12. Schaumburg, H.H.,Byck, R.B.,Weller, R.O.(1970).The effect of phenol on peripheral nerve. A histological and electrophysiological study.J. Neuropathol. Exp. Neurol.,29,615-630.
13. Sung, D.H.(2004).Locating the target nerve and injectate spread in rabbit sciatic nerve block.Reg. Anesth. Pain Med.,29,194-200.
14. Sung, D.H.,Han, T.R.,Park, W.H.,Je Bang, H.,Kim, J.M.,Chung, S.H.,Woo, E.J.(2001).Phenol block of peripheral nerve conduction: titrating for optimum effect.Arch. Phys. Med. Rehabil.,82,671-676.
15. Superville-Sovak, B.,Rasminsky, M.,Finlayson, M.H.(1975).Complications of phenol neurolysis.Arch. Neurol.,32,226-228.
16. Wood, K.M.(1978).The use of phenol as a neurolytic agent: a review.Pain,5,205-229.
17. Wu, J.J.,Wang, K.L.,Mao, I.F.,Chen, M.L.,Hsia, S.M.,Wang, P.S.(2010).Effects of oral nonylphenol on testosterone production in rat Leydig cells.Adapt. Med.,2,47-52.
18. Zafonte, R.D.,Munin, M.C.(2001).Phenol and alcohol blocks for the treatment of spasticity.Phys. Med. Rehabil. Clin. N. Am.,12,817-832.

1. Zhao, Peng,Sun, Hong-Xu,Hou, Yi-Ping,Chu, Min(2016).Inhibitory Effects of Botulinum Toxin Type A on Pyloric Cholinergic Muscle Contractility of Rat.中國生理學雜誌,59(4),218-224.