What are the differences between alcohol and phenol neurolysis?
Neurolysis can be accomplished with either alcohol or phenol. Alcohol for neurolysis is usually used in concen-trations of 50–70%. It causes neurolysis by extracting cholesterol, phospholipids, and cerebrosides and caus-ing precipitation of lipoproteins and mucoproteins. This results in damage to both the Schwann cell and the axon. Clinically, alcohol is painful on injection and is hypobaric if used for intrathecal neurolysis. Relative to phenol, alco-hol may be more potent with a longer duration of action.
Phenol’s primary neurolytic effect is by coagulation of proteins. It also causes nonselective damage to neural tissue. Secondarily, phenol might have a local anesthetic effect. Intrathecally, phenol is hyperbaric. Phenol has a great affin-ity for vascular tissue and injury to adjacent blood vessels must be considered when it is used. For this reason, many pain specialists prefer alcohol to phenol for celiac plexus blocks. Radiofrequency lesioning, cryoablation, and glycerol are other modalities used for neurolysis.