Neurolysis, the targeted disruption of neural pathways through thermal or chemical means, represents a valuable intervention for pain management across various clinical contexts. At Queen Elizabeth Hospital, our pain service has successfully implemented neurolytic procedures for acute, chronic, and cancer-related pain conditions. This presentation focuses specifically on our approach employing neurolysis for geriatric hip fracture patients when conventional management is not feasible.
Our approach addresses a critical clinical challenge: elderly patients with femoral neck or trochanteric fractures who present with poor premorbid functional status, multiple comorbidities, and concurrent medical conditions. These factors collectively elevate anaesthetic and surgical risks, often rendering conventional fracture fixation procedures hazardous. For this vulnerable population, effective pain management becomes paramount when definitive surgical intervention is contraindicated.
The neurolytic technique involves a precise two-step procedure targeting the articular branches of the hip joint. Initial injection of local anaesthetics confirms accurate needle placement and provides immediate analgesia, followed by administration of absolute alcohol to achieve long-lasting neural disruption. This approach has been standardized with comprehensive pre-procedural assessment protocols and dedicated follow-up programs to ensure optimal outcomes.
Preliminary results from our case series are promising, demonstrating significant pain reduction and improved mobility within the constraints of patients' baseline functional limitations. More importantly, this intervention has allowed for enhanced quality of life for patients who would otherwise experience prolonged, poorly controlled pain.
This presentation will detail our patient selection criteria, procedural technique, outcome measures, and case examples illustrating the efficacy of this approach in this challenging patient population.
