Effectiveness Of Ultrasound-guided Peripheral Neurolytic Blocks In Patients With Severe Spasticity

[ Objective ] To evaluate the clinical effectiveness of ultrasound guided peripheral nerve blocks for the treatment of severe spasticity in individuals andexplore the potential value of this method on locating the peripheral nerves . [ Methods ] Fifteen patients (mean age, 31.53 ± 10.5 yr; mean duration to block,11.37±4.14 mo) with severe spasticity (modified Ashworth scale[MAS] score ≥ 2) secondary to cerebrovascular accidents , traumatic brain injuries and anoxic encephalopathy whose walking and standing were limited and the muscle spasm no obviously relief by movement therapy and physical therapy. Nerve blocks were performed via a approach using ultrasonograph to identify the peripheral nerve truck and were performed by injection of ≥ 99.7% ethanol or 1 %lidocaine .Fifteen patients include 2 cases of elbow flexor spasticity, 11 cases of ankle spasticity and 2 cases of knee flexor spasticity were located in musculocutaneous nerve, tibial nerve and sciatic nerve by ultrasound respectively. The severity of spasticity was assessed using the Modified Ashworth Scale (MAS) score .[Results] 1. Ultrasonography can clearly detect the peripheral nerve which appeared as tubular echogenic structure with parallel linear echoes on long axis views, and as round echogenic structure with punctiform echoes on transverse views. The display value of the ultrasonography was 100%(15/15). 2 . Ultrasound can real display the needle tip when it near the target nerve and proved the ultrasound guideis accurate, the accurat valuen of ultrasound guided is 100%(15/15). The minimum stimulus intensity is 0.2-0.4 mA in sciatic nerve, 0.2-0.6mA in tibial nerve and 0-0.4mA in musculocutaneous nerve respectively. 3. The MAS score was reduced in 5 patients injected by 1%lidocaine during the 30- minute follow-up (3.4 + 0.89 versus 2.1 ±0.89) and 10 patients injected by≥ 99.7% ethanol during the 4-week follow-up (3.2 ± 0.42 versus 1.8±0.75). Compared with scores measured before and after the block, MAS scores were significantly improved (P<0.05) . No obvious complications occurred.[ Conclusions ] The treatment of severe spasticity with ultrsound guided peripheral nerve blocks proved to be an accurate, safety, simple, highly successful and reproducible approach, which represents a new technique and is worth to usedwidely in clinic practice.