A Study to Evaluate the Effectiveness of Phenol Blocks to Peripheral Nerves in Reducing Spasticity in Patients with Paraplegia and Brain Injury

Primary objective: To evaluate effectiveness of phenol blocks of peripheral nerves in reducing spasticity brain injured and spinal cord injured patients. Secondary objectives: To measure the change in the range of motion after phenol blocks to peripheral nerves, to identify the electrophysiological changes and to study the cost effectiveness and side effects of phenol blocks. Study design: Descriptive study Setting: Tertiary referral centre, India. Methods: This study was conducted from March 2000 to January 2002 among 20 patients with spasticity. Spasticity was measured by modified Ashworth scale and range of motion was measured with a standard goniometer on 1st, 7th, 14th and 21st days of the study. Nerve conduction studies, gait analysis, and functional independence measure was measured on 1st and 21st day of the study. Nerve blocks were done on 7th and 14th day of the study with 0.5% bupivacaine and 6% phenol in water respectively. Results: 20 patients were included in the study, out of which 85% had spinal cord injury and 15% patients had brain injury sequelae. Spasticity measured by modified Ashworth scale, showed a statistically significant reduction with neurolysis. Following obturator neurolysis abduction of hip joint improved significantly and with posterior tibial neurolysis there was significant improvement in dorsiflexion and plantar flexion range of the ankle joint. Functional improvement measured with the FIM score also showed statistically significant improvement after neurolysis. H reflex amplitude was significantly reduced following neurolysis. There was a statistically significant reduction in the consumption of systemic medications for spasticity following the injection. Conclusion: Range of motion in neighboring joints improved significantly after blockade of spasticity using Phenol neurolysis. There was statistically significant reduction in the amplitude of the H reflex. There were no major adverse effects following neurolysis with phenol and it was found to be significantly cost effective when compared to systemic antispastic medications.