Neurolysis: Nerve Decompression for Pain Relief – Techniques and Risks

Neurolysis = deliberate disruption of nerve continuity or perineural adhesions to relieve pain from entrapment/compression.

Techniques

Percutaneous (Chemical) Neurolysis

Image-guided (US/fluoroscopy/CT) injection of alcohol (50–100%), phenol (5–10%), or cryoablation near target nerve. Used for celiac plexus, splanchnic, intercostal, genitofemoral, Morton's neuroma.

Surgical (Open/Endoscopic) Neurolysis

Direct visualization, release of compressive fascia/bands, external neurolysis (epineurectomy). For carpal tunnel, cubital tunnel, tarsal tunnel, thoracic outlet.

Radiofrequency Ablation (RFA)

Thermal lesion of medial branch nerves (facetogenic pain) or peripheral nerves. Not true neurolysis (no structural disruption), but functional denervation.

Risks

• Dysesthesia, neuroma formation, motor weakness, deafferentation pain.
• Chemical: tissue necrosis if extravasation.

Indications

Refractory neuropathic pain after failed conservative/medical management; diagnostic block confirmation required.