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Nerve Blocks and Neurolysis J. David Prologo, MD
NerveBlocksandNeurolysis
J.DavidPrologo,MD
DisclosuresJ.DavidPrologo:Consultant– BTG,MeritMedical;Grant/ResearchSupport– BTG,Healthtronics
Brandnamesareincludedinthispresentationforparticipantclarificationpurposesonly.Noproductpromotionshouldbeinferred.
Division of Interventional Radiology andImage-guided Medicine
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Complex “Blocks” (Cryoneurolysis)
Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
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Temperature Mediated Injury to Nerves+10⁰ C
Temporary
signaling
inactivation
-20⁰ C
Axonotmesis
-5⁰ C
Conduction
block lasting
hours - days
Na/K pump
disruption
Axonal and myelin degeneration
Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
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Nerve Injury
Ilfeld BM, et al. Expert Rev Med Devices. 2016;13(8):713-725.
Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
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Nerve Injury
Trescot AM. Pain Physician. 2003;6(3):345-360.
Division of Interventional Radiology andImage-guided Medicine
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L4 Radiculopathy
Division of Interventional Radiology andImage-guided Medicine
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VIP Story
Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
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Inpatients
N = 12
∆ VAS = 5.2 (p<0.0001)
Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
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S1
67-year-old male with
intractable right S1
radiculopathy. Pt has metastatic
renal cell carcinoma and a
known sacral lesion, which has
been radiated twice.
Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
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Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
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Don’t stab the nerve
8-10, 3, 8-10, 3 if possible
First 24 hours
Manage expectations
Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
WINSHIP CANCER INSTITUTE
Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
WINSHIP CANCER INSTITUTE
Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
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L5
Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
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T11
Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
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Is This New?
Division of Interventional Radiology andImage-guided Medicine
Emory University Hospital, Emory University Hospital Midtown,Children’s at Egleston, Grady Memorial Hospital, Emory Saint Josephs and Emory Johnscreek
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Questions?
