Fenol como agente neurolítico no tratamento da espasticidade focal e multifocal
DOI:
https://doi.org/10.11606/issn.2317-0190.v26i1a163003Palavras-chave:
Fenol, Espasticidade Muscular, Bloqueio Nervoso, TerapêuticaResumo
A síndrome piramidal ocorre nas lesões do sistema nervoso central que afetam as vias corticoespinhais e são definidas pela tríade de fraqueza muscular, aumento dos reflexos miotáticos e espasticidade, que é definida pelo aumento involuntário da resistência ao movimento passivo cuja intensidade varia com a velocidade do movimento. Quando a espasticidade interfere na funcionalidade do paciente, dificultando o movimento ativo, causando dor ou dificultando a prestação de cuidados por terceiros, há necessidade de iniciar seu tratamento. Para o tratamento da espasticidade generalizada ou de grandes porções do corpo, a intervenção medicamentosa ocorre por via oral ou intratecal, conforme os recursos disponíveis, mas efeitos colaterais de intensidade variável e indesejáveis podem ocorrer, especialmente o comprometimento da atenção ou da consciência, que prejudicam o processo de reabilitação. O tratamento focal da espasticidade utiliza a toxina botulínica ou os bloqueios nervosos com fenol ou álcool. Este artigo revisa a literatura sobre as técnicas mais adequadas para realizar a neurólise com fenol. Os bloqueios neuromusculares com fenol são um tratamento efetivo, de ação imediata, baixo custo, duração prolongada e de poucos efeitos adversos quando são respeitados os cuidados regulares de aplicação.
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Referências
Lianza S, Musse CI, Bernardo W, Silvinato A, Simões R. Neurólise com fenol no tratamento da espasticidade. Med Reabil. 2015;34(3):79-81.
Mullins D, Winter A, Fini N, Dixon C, Aldous S, Palit M, et al. Frequency and characteristics of goal attainment following BoNT-A injection for management of spasticity. Disabil Rehabil. 2016;38(19):1927-33. DOI: https://doi.org/10.3109/09638288.2015.1107781
Laxe S. Which interventions are useful for managing muscle spasticity in individuals who sustained traumatic brain injury? - A Cochrane Review summary with commentary. NeuroRehabilitation 2019;44(1):157-9. DOI: https://doi.org/10.3233/NRE-189003
Escaldi S. Neurolysis: a brief review for a fading art. Phys Med Rehabil Clin N Am. 2018;29(3):519-27. DOI: https://doi.org/10.1016/j.pmr.2018.03.005
Ward AB. Spasticity treatment with botulinum toxins. J Neural Transm (Vienna). 2008;115(4):607-16. DOI: https://doi.org/10.1007/s00702-007-0833-2
Ghai A, Garg N, Hooda S, Gupta T. Spasticity - Pathogenesis, prevention and treatment strategies. Saudi J Anaesth. 2013;7(4):453-60.
Kolaski KL, Logan LR. Intrathecal baclofen in cerebral palsy: A decade of treatment outcomes. J Pediatr Rehabil Med. 2008;1(1):3-32.
Khalili AA, Harmel MH, Forster S, Benton JG. Management of spasticity by selective peripheral nerve block with dilute phenol solutions in clinical rehabilitation. Arch Phys Med Rehabil. 1964;45:513-9.
Jozefczyk PB. The management of focal spasticity. Clin Neuropharmacol. 2002;25(3):158-73.
Botte MJ, Abrams RA, Bodine-Fowler SC. Treatment of acquired muscle spasticity using phenol peripheral nerve blocks. Orthopedics. 1995;18(2):151-9.
Halpern D, Meelhuysen FE. Phenol motor point block in the management of muscular hypertonia. Arch Phys Med Rehabil. 1966;47(10):659-64.
Wood KM. The use of phenol as a neurolytic agent: a review. Pain. 1978;5(3):205-29.
Matthews DJ, Balaban B. Management of spasticity in children with cerebral palsy. Acta Orthop Traumatol Turc. 2009;43(2):81-6. DOI: https://doi.org/10.3944/AOTT.2009.081
Crema CMT, Santos APBC, Magário APT, Caldas CACT, Riberto M. Neuromuscular block practice in the treatment of spasticity in Brazil. Acta Fisiatr. 2016;23(3):150-4. DOI: https://doi.org/10.5935/0104-7795.20160029
Felsenthal G. Felsenthal G. Pharmacology of phenol in peripheral nerve blocks: a review. Arch Phys Med Rehabil. 1974;55(1):13-6.
Tilton AH. Management of spasticity in children with cerebral palsy. Semin Pediatr Neurol. 2004;11(1):58-65.
Sposito MMM. Bloqueios químicos para o tratamento da espasticidade na paralisia cerebral. Acta Fisiátr. 2010;17(2):68-83. DOI: https://doi.org/10.11606/issn.2317-0190.v17i2a103314
Viel E, Pellas F, Ripart J, Pélissier J, Eledjam JJ. Peripheral nerve blocks and spasticity. Why and how should we use regional blocks? Presse Med. 2008;37(12):1793-801. DOI: https://doi.org/10.1016/j.lpm.2008.07.007
Kwon JY, Kim JS. Selective blocking of the anterior branch of the obturator nerve in children with cerebral palsy. Am J Phys Med Rehabil. 2009;88(1):7-13. DOI: https://doi.org/10.1097/phm.0b013e31815b6381
Yadav SL, Singh U, Dureja GP, Singh KK, Chaturvedi S. Phenol block in the management of spastic cerebral palsy. Indian J Pediatr. 1994;61(3):249-55.
Elovic EP, Esquenazi A, Alter KE, Lin JL, Alfaro A, Kaelin DL. Chemodenervation and nerve blocks in the diagnosis and management of spasticity and muscle overactivity. PM R. 2009;1(9):842-51. DOI: https://doi.org/10.1016/j.pmrj.2009.08.001
Brashear A, Lambeth K. Spasticity. Curr Treat Options Neurol. 2009;11(3):153-61.
Petrillo CR, Chu DS, Davis SW. Phenol block of the tibial nerve in the hemiplegic patient. Orthopedics. 1980;3(9):871-4.
Gracies JM, Elovic E, McGuire JR, Zorowitz R. Traditional pharmacologic treatments for spasticity part i: local treatments. In: Brasher A, Mayer NH. Spasticity: etiology, evaluation, management, and the role of botulinum toxin. New York: Wemove; 2008. p.119-41.
Satkunam LE. Rehabilitation medicine: 3. Management of adult spasticity. CMAJ. 2003;169(11):1173-9.
O'Brien CF. Treatment of spasticity with botulinum toxin. Clin J Pain. 2002;18(6 Suppl):S182-90.
Gormley ME Jr, Krach LE, Piccini L. Spasticity management in the child with spastic quadriplegia. Eur J Neurol. 2001;8 Suppl 5:127-35.
Karri J, Mas MF, Francisco GE, Li S. Practice patterns for spasticity management with phenol neurolysis. J Rehabil Med. 2017;49(6):482-8. DOI: https://doi.org/10.2340/16501977-2239
Deltombe T, De Wispelaere JF, Gustin T, Jamart J, Hanson P. Selective blocks of the motor nerve branches to the soleus and tibialis posterior muscles in the management of the spastic equinovarus foot. Arch Phys Med Rehabil. 2004;85(1):54-8. DOI: https://doi.org/10.1016/S0003-9993(03)00405-2
Patel DRL, Soyode O. Pharmacologic interventions for reducing spasticity in cerebral palsy. Indian J Pediatr. 2005;72(10):869-72.
Barnes MP. Management of spasticity. Age Ageing. 1998;27(2):239-45. DOI: https://doi.org/10.1093/ageing/27.2.239
Yoshida T, Nakamoto T, Kamibayashi T. Ultrasound-guided obturator nerve block: a focused review on anatomy and updated techniques. Biomed Res Int. 2017;2017:7023750. DOI: https://doi.org/10.1155/2017/7023750
Magora F, Rozin R, Ben-Menachem Y, Magora A. Obturator nerve block: an evaluation of technique. Br J Anaesth. 1969;41(8):695-8.
Gasparich JP, Mason JT, Berger RE. Use of nerve stimulator for simple and accurate obturator nerve block before transurethral resection. J Urol. 1984;132(2):291-3. DOI: https://doi.org/10.1016/s0022-5347(17)49600-5
Choquet O, Capdevila X, Bennourine K, Feugeas JL, Bringuier-Branchereau S, Manelli JC. A new inguinal approach for the obturator nerve block: anatomical and randomized clinical studies. Anesthesiology. 2005;103(6):1238-45. DOI: https://doi.org/10.1097/00000542-200512000-00020
Wassef MR. Interadductor approach to obturator nerve blockade for spastic conditions of adductor thigh muscles. Reg Anesth. 1993;18(1):13-7.
Ghai A, Sangwan SS, Hooda S, Garg N, Kundu ZS, Gupta T. Evaluation of interadductor approach in neurolytic blockade of obturator nerve in spastic patients. Saudi J Anaesth. 2013;7(4):420-6. DOI: https://doi.org/10.4103/1658-354x.121074
Kakinohana M, Taira Y, Saitoh T, Hasegawa A, Gakiya M, Sugahara K. Interadductor approach to obturator nerve block for transurethral resection procedure: comparison with traditional approach. J Anesth. 2002;16(2):123-6. DOI: https://doi.org/10.1007/s005400200006
Jang SH, Ahn SH, Park SM, Kim SH, Lee KH, Lee ZI. Alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle to treat ankle spasticity in patients with hemiplegic stroke. Arch Phys Med Rehabil. 2004;85(3):506-8. DOI: https://doi.org/10.1016/S0003-9993(03)00468-4
Sook Kim H, Hye Hwang J, Lee PK, Kwon JY, Yeon Oh-Park M, Moon Kim J, et al. Localization of the motor nerve branches and motor points of the triceps surae muscles in korean cadavers. Am J Phys Med Rehabil. 2002;81(10):765-9. DOI: https://doi.org/10.1097/00002060-200210000-00008
Anwar F, Mee H, Ramanathan S. Phenol nerve block for ankle plantar flexor and invertor spasticity in upper motor neuron lesion: a case series. J Int Soc Phys Rehabil Med. 2018;1:55-60.
Creze M, Peltier J, Havet E, Potier A, Lefranc M, Foulon P, et al. Anatomy and surgical landmarks for the ansa pectoralis: application to pectoralis major nerve selective neurotomy. Surg Radiol Anat. 2012;34(10):943-51. DOI: https://doi.org/10.1007/s00276-012-0990-3
Sefa Özel M, Özel L, Toros SZ, Marur T, Yıldırım Z, Erdoğdu E, et al. Denervation point for neuromuscular blockade on lateral pectoral nerves: a cadaver study. Surg Radiol Anat. 2011;33(2):105-8. DOI: https://doi.org/10.1007/s00276-010-0712-7
Kong KH, Chua KS. Neurolysis of the musculocutaneous nerve with alcohol to treat poststroke elbow flexor spasticity. Arch Phys Med Rehabil. 1999;80(10):1234-6. DOI: https://doi.org/10.1016/S0003-9993(99)90021-7
