Neurolytic and Nonneurolytic Blocks in Pain Management

Abstract

Abstract As this chapter discusses, neurolytic blocks involve the destruction of afferent somatic or sympathetic nerves. This can be accomplished with a variety of methods, including radio-frequency ablation, cryoablation, and injection of alcohol, glycerol, or phenol. Choice of technique depends on the target and indications for the procedure. Diagnostic nerve blocks should precede most neurolytic blocks to ensure the correct target (and adequate relief of the patient’s pain) prior to neurolysis. Common neurolytic blocks include celiac plexus block, superior hypogastric plexus block, ganglion impar block, lumbar sympathetic block, and stellate ganglion block. Nonneurolytic blocks with local anesthetics can be performed not only for perioperative pain, but also in the setting of chronic or cancer pain. Generally, nonneurolytic blocks provide short-term relief, but can provide pain relief beyond the duration of the local anesthetic in chronic pain patients. Nonneurolytic blocks also allow for opportunities for physical therapy and strengthening and can help reduce opioid use in acute and chronic pain.