Ultrasound-Guided Alcohol Neurolysis For Treatment of Refractory Radial Neuralgia

Background: The radial nerve is especially vulnerable to injury due to its location near the humerus. When acute painbecomes chronic and surgical repair is no longer an option, it is necessary to have non-opioid, nonpharmacologicalmethods of pain relief.Case Report: A 63-year-old man presented with severe radial nerve neuralgia secondary to traumatic left upper extremityinjury 40 years ago. After several unsuccessful surgical interventions and failing medication management,he was sent to pain management as a last resort prior to elective amputation of the left upper limb.After initial evaluation, the patient underwent a diagnostic ultrasound-guided radial nerve block at themidhumeral level with complete but short-lasting relief of his pain. Shortly after, we performed ultrasoundguidedalcohol neurolysis of the radial nerve at the same level. This treatment resulted in 100% pain relieffor 10 months with gradual resumption of pain to previous levels at 12 months post neurolysis.Conclusion: Alcohol neurolysis is an effective and viable option for the treatment of neuralgia resistant to other therapeuticmodalities. To our knowledge, this is the first case report that describes the use of ultrasound toperform chemical neurolysis of the radial nerve.Key words: Alcohol neurolysis, chronic pain, nerve ablation, neuralgia, neurolysis, opioids, radial nerve, traumaticinjury, ultrasound