nerve blocks and neurolysis · nerve blocks and neurolysis j. david prologo, md. disclosures j....
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NerveBlocksandNeurolysis
J.DavidPrologo,MD
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DisclosuresJ.DavidPrologo:Consultant– BTG,MeritMedical;Grant/ResearchSupport– BTG,Healthtronics
Brandnamesareincludedinthispresentationforparticipantclarificationpurposesonly.Noproductpromotionshouldbeinferred.
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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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Complex “Blocks” (Cryoneurolysis)
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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
WINSHIP CANCER INSTITUTE
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
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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
WINSHIP CANCER INSTITUTE
Nerve Injury
Ilfeld BM, et al. Expert Rev Med Devices. 2016;13(8):713-725.
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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
WINSHIP CANCER INSTITUTE
Nerve Injury
Trescot AM. Pain Physician. 2003;6(3):345-360.
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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
WINSHIP CANCER INSTITUTE
L4 Radiculopathy
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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
WINSHIP CANCER INSTITUTE
VIP Story
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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
WINSHIP CANCER INSTITUTE
Inpatients
N = 12
∆ VAS = 5.2 (p<0.0001)
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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
WINSHIP CANCER INSTITUTE
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.
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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
WINSHIP CANCER INSTITUTE
![Page 12: Nerve Blocks and Neurolysis · Nerve Blocks and Neurolysis J. David Prologo, MD. Disclosures J. David Prologo: Consultant –BTG, Merit Medical; Grant/Research Support –BTG, Healthtronics](https://reader030.vdocuments.us/reader030/viewer/2022041007/5eadc5ece926d3261e729ff7/html5/thumbnails/12.jpg)
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
Don’t stab the nerve
8-10, 3, 8-10, 3 if possible
First 24 hours
Manage expectations
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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
WINSHIP CANCER INSTITUTE
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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
WINSHIP CANCER INSTITUTE
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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
WINSHIP CANCER INSTITUTE
L5
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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
WINSHIP CANCER INSTITUTE
T11
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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
WINSHIP CANCER INSTITUTE
Is This New?
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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
WINSHIP CANCER INSTITUTE
Questions?