Ultrasound-Guided Alcohol Neurolysis for Poststroke Upper Limb Spasticity to Facilitate Arteriovenous Fistula Creation in Hemodialysis: A Case Report.
Ruoxi Cao, Jia Yi Sandra Lau, Deepali Bang and 1 others
PMID 42769645WHAT IT FOUND
In one dialysis-dependent stroke survivor, ultrasound-guided alcohol neurolysis of arm nerves reduced spasticity and pain and improved positioning, allowing fistula creation.
It was given with stretching, orthoses, strengthening, electrical stimulation and lidocaine, so its independent effect is unclear.
Key findings
01Botulinum toxin reduced pain from 8 of 10 to 3 of 10 and allowed seated dialysis, but did not improve tone or range enough for AVF creation.
02Alcohol neurolysis decreased elbow, forearm and wrist spasticity, with further reduction by 28 days.
03Thirteen days after alcohol neurolysis, the patient had right radiocephalic AVF creation under local anesthesia, and correspondence later confirmed fistula maturation and hemodialysis use.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a single case report, so it describes what happened to one patient and does not show that the treatment works for others. The patient also received a comprehensive rehabilitation program and earlier botulinum toxin, so the separate effect of the alcohol nerve block cannot be isolated. In-person follow-up was only 28 days, and the patient moved overseas, so long-term spasticity recurrence, function and fistula patency were not assessed directly. The patient had kidney failure, severe generalized spasticity and recent stroke, so it is not clear how this applies to patients without those features.
Declared interests
The authors reported no financial or nonfinancial disclosures related to this project. Ethics approval was waived by the institutional review board, and written informed consent was obtained for publication.
The easy way to misread this
Do not conclude that alcohol neurolysis alone caused the improvement or should be used routinely. This was one case, and the block was given within a rehabilitation program that also included stretching, orthoses, strengthening, electrical stimulation, lidocaine and earlier botulinum toxin, so its separate contribution cannot be isolated.