Neurolytic CPB cocktail

[PMROralBoards]

What mixture do you typically use for a neurolytic block? I did a bunch in fellowship but do not remember the % and volume of phenol used along with lidocaine or bupi. Cancer related liver capsule distention pain. I’ve only done it for pancreatic CA in the past, but will be trying it for this as a last ditch before the patient getting a pump. Thank you

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[Ducttape]

Phenol 8% 5 ml with 10 ml 0.25% bupiv, followed by flushing out the tubing and needle with saline or 1% lidocaine in transaortic approach.

 

[Orin]

What mixture do you typically use for a neurolytic block? I did a bunch in fellowship but do not remember the % and volume of phenol used along with lidocaine or bupi. Cancer related liver capsule distention pain. I’ve only done it for pancreatic CA in the past, but will be trying it for this as a last ditch before the patient getting a pump. Thank you

I generally warn people that the liver capsule's innervation appears to be more off the lower intercostals than the celiac plexus. I might consider a T8-T10 intercostal blocks as neurolysis of that might be more effective than the CP neurolysis for distension related pain.

 

[PMROralBoards]

I generally warn people that the liver capsule's innervation appears to be more off the lower intercostals than the celiac plexus. I might consider a T8-T10 intercostal blocks as neurolysis of that might be more effective than the CP neurolysis for distension related pain.

That’s interesting- I’ve never heard of that. I will look into it. Thank you for the info!

 

[NVO]

Dehydrated alcohol 98% ~8ml (three 5ml vials divided into 2 syringes) with ~4ml 0.5% bupi for 12ml per syringe. Flush tubing. Lidocaine 2% prior to giving injectate. For the bilateral retrocrural splanchnic approach. Have to be careful with the amount of local, use only a few cc lidocaine 1% to anesthetize the tract

 

[mygalperin]

What mixture do you typically use for a neurolytic block? I did a bunch in fellowship but do not remember the % and volume of phenol used along with lidocaine or bupi. Cancer related liver capsule distention pain. I’ve only done it for pancreatic CA in the past, but will be trying it for this as a last ditch before the patient getting a pump. Thank you

Phenol 6%, but it is difficult to get nowdays, alternative is 98% alcohol