Table Of ContentTECHNIQUES OF NEUROLYSIS
CURRENT MANAGEMENT OF PAIN
P. PRITHVI RA]. SERIES EDITOR
The series, Current Management of Pain, is intended by the series editor and
the publishers to provide up-to-date information on advances in the clinical
management of acute and chronic pain and related research as quickly as
possible. Both the series editor·and the publishers felt that, although compre
hensive texts are now available, they do not alway cover the rapid advances
in this field. Another format was needed to publish advances in basic sciences
and clinical modalities and to bring them rapidly to the practitioners in the
community. A questionnaire was sent to selected clinicians and, based on
their responses, topics were chosen by the series editor. Editors of each
volume were chosen for their expertise in the field and their ability to
encourage other active pain specialists to contribute their knowledge:
Ghia, J.N., ed.: The Multidisciplinary Pain Center: Organization and Per
sonnel Functions for Pain Management, 1988. ISBN 0-89838-359-5.
Lynch, N.T., Vasudevan, S.V.: Persistent Pain: Psychosocial Assessment
and Intervention. 1988. ISBN 0-89838-363-3.
Abram, S.E., ed.: Cancer Pain, 1988. ISBN 0-89838-389-7.
Racz, G.B., ed.: Techniques of Neurolysis, 1989. ISBN 0-89838-397-8.
TECHNIQUES OF NEUROLYSIS
EDITED BY GABOR B. RACZ
....
"
Springer Science+Business Media, LLC
Copyright 1989 by Springer Science+Business Media New York
Originally published by Kluwer Academic Publishers, Boston in 1989.
Softcover reprint of the hardcover 1s t edition 1989
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system
or transmitted in any form or by any means, mechanical, photocopying, recording, or other
wise, without the prior written permission ofthe publisher, Springer Science+Business Media,
LLC
Library of Congress Cataloging-in-Publication Data
Techniques of neurolysis / edited by Gabor B. Racz.
p. cm.-(Current management ofpain; 4)
Includes index.
ISBN 978-1-4899-6723-7 ISBN 978-1-4899-6721-3 (eBook)
DOI 10.1007/978-1-4899-6721-3
1. Conduction anesthesia. I. Racz, Gabor, 1937- . 11. Tide: Neurolysis. III. Series.
[DNLM: 1. Chronic Disease-therapy. 2. Nerve Block-methods.
3. Pain-surgery. WO 375 T255)
RD84.T431988
617'.964-dc19
DNLM/DLC
for Library ofCongress 88-13005
CIP
CONTENTS
Contributing authors Vll
Series editor foreword xi
Preface xii
1. The history of neurolytic block 1
MARK SWERDLOW
2. Pharmacology of neurolytic agents 13
WILLIAM H. LY NESS
3. Gross and microscopic lesions produced by phenol neurolytic procedures 27
JAMES E. HEAVNER, GABOR B. RACZ
4. Subarachnoid and other clinical uses of phenol 33
J.W. LLOYD
5. Subarachnoid alcohol block 45
JANNA BLANCHARD, SOMAYAJI RAMAMURTHY
6. Lysis of adhesions in the epidural space 57
GABOR B. RACZ, JERRY T. HOLUBEC
7. Hypertonie saline and corticosteroid injected epidurally for pain control 73
GABOR B. RACZ, JAMES E. HEAVNER, WRIGHT SINGLETON, MARYLIDA CARLINE
8. Epidural fibrosis: Experimental model and therapeutic alternatives 87
ROBERT F. MCCARRON
vi Contents
9. Technical advance: New epidural adapter and epidural needle 95
GABOR B. RACZ, WILLIAM M. KLINE
10. Neurolytic blocks around the head 99
SAMPSON LIPTON
11. Percutaneous Retrogasserian glycerol rhizotomy in the treatment of
trigeminal neuralgia 125
GARY S. FELDSTEIN
12. Stellate ganglion phenol neurolysis 133
GABOR B. RACZ, JERRY T. HOLUBEC
13. Radiofrequency lesions of the communicating ramus in the treatment of
low back pain 145
MENNO E. SLUlJTER
14. The role of celiac plexus block in intractable upper abdominal pain 161
SUBHASH JAIN
15. Radiofrequency percutaneous lumbar sympathectomy: Technique and review
of indications 171
K. SRI KANTHA
16. Neurolytic blocks of peripheral nerves 185
STEPHEN E. ABRAM
17. Repeat Epidural Phenol Injections in Chronic Pain and Spasticity 193
GABOR B. RACZ, JAMES E. HEAVNER, ROBERT HAYNSWORTH
Index 213
CONTRIBUTING AUTHORS
Stephen E. Abram, M.D.
Professor and Vi ce-Chairman
Department of Anesthesiology
Medical College of Wisconsin
8700 West Wisconsin Avenue
Milwaukee, Wisconsin 53226
Janna Blanchard, M.D.
Fellow in Anesthesia
Department of Anesthesiology
The University of Texas Health Science Center at San Antonio
7703 Floyd Curl Drive
San Antonio, Texas 78284
Marylida Carline
Medical Student
Texas Tech University Health Sciences Center
Lubbock, Texas 79430
Gary S. Feldstein, M.D.
Department of Anesthesia
St Lukes/Roosevelt Hospital Center
428 West 59th Street
New York, New York 10019
Robert Haynsworth, M.D.
3707 Gaston Avenue
Suite 611
Dallas, Texas 75246
vii
viii Contributing authors
James E. Heavner, D.V.M., Ph.D.
Department of Physiology
Texas Tech University Health Sciences Center
Lubbock, Texas 79430
Jerry T. Holubec, D.O.
Pain Fellow/Resident in Anesthesia
Texas Tech University Health Sciences Center
Lubbock, Texas 79430
Subhash Jain, M.D.
Director of Nerve Block Service
Clinical Assistant Professor
Department of Anesthesiology and Critical Care Medicine
Cornell University Medical College
Memorial Sloan-Kettering Cancer Center
1275 York Avenue
New York, New York 10021
K. Sri Kantha, M.D., F.F.A.R.C.S.
Director Pain Management Center
Saint Mary's Hospital
Orange, New Jersey 07050
William M. Kline, Ph.D.
Medical Evaluation Devices and Instruments Corporation (MEDIC)
Gloversville, New Y ork 12078
Sampson Lipton, M.D., F.F.A.R.C.S.
Director
The Pain Relief Foundation
Rice Lane
Liverpool L9 1AE
United Kingdom
].W. Lloyd, M.A., F.F.A.R.C.S.
Oxford Regional Pain Relief Unit
Abingdon Hospital
Marcham Road
Abingdon, Oxon
United Kingdom
ix
William H. Lyness
Associate Professor
Department of Pharmacology
Texas Tech University Health Sciences Center
Lubbock, Texas 79430
Robert F. McCarron, M.D.
Department of Orthopedic Surgery
Texas Tech University Health Sciences Center
Lubbock, Texas 79430
Gabor B. Racz, M.D.
Chairman, Department of Anesthesia
Texas Tech University Health Sciences Center
Lubbock, Texas 79430
Somayaji Ramamurthy, M.D.
Professor in Anesthesia
The Department of Anesthesiology
The University of Texas Health Science Center at San Antonio
7703 Floyd Curl Drive
San Antonio, Texas 78284
Wright Singleton
Medical Student
Texas Tech University Health Sciences Center
Lubbock, Texas 79430
Menno E. Sluijter, M.D.
The Pain Relief Unit
Boveny Ziekenhuis
Amsterdam
The Netherlands
Mark Swerdlow, M.D., M.Sc., F.F.A.R.C.S.
Honorary Consultant
North West Regional Pain Relief Centre
Hope Hospital
University of Manchester School of Medicine
Manchester
United Kingdom
