title: Ultrasound and electrical stimulator-guided obturator nerve block with phenol in the treatment of hip adductor spasticity in long-term care patients: a randomized, triple blind, placebo controlled study.
abstract: OBJECTIVE
  To evaluate the effectiveness of ultrasound-guided phenol nerve block in the treatment of severe hip adductor spasticity in long-term care patients.
  
  
  METHODS
  Double-blind placebo-controlled trial with a 9-month follow-up period.
  
  
  METHODS
  A 250-bed long-term care hospital and the infirmary units of 5 regional hospitals.
  
  
  METHODS
  Twenty-six long-term care patients with bilateral severe chronic hip adductor spasticity affecting perineal hygiene and nursing care.
  
  
  METHODS
  Patients were randomized to 2 groups that received ultrasound and electrical stimulator guided obturator nerve block using either 5% phenol in aqueous solution or saline.
  
  
  METHODS
  The primary outcome measure was the Modified Ashworth Scale, which reflected the severity of hip adductor spasticity. Secondary outcomes included Goal Attainment Scale (GAS), hygiene score, distances between the knees during fast and slow passive hip abductions; passive range of movement for hip extension and knee extension. Pain was assessed using the Pain Assessment in Advanced Dementia Scale.
  
  
  RESULTS
  Twenty-six patients (7 males; mean age = 77, standard deviation = 14) were recruited. At week 6 post-injection, 12/16 (75%) patients in the treatment group vs 1/10 (10%) patients in the control group had at least 1-point reduction of Modified Ashworth Scale (P = .001) on both hip adductors. There was also significant improvement in the GAS, as well as the hygiene score, resting position, and distances between the knees during fast and slow passive hip abductions in the treatment group, which persisted until week 36. No significant difference in the Pain Assessment in Advanced Dementia Scale was found between the 2 groups. No serious phenol nerve block related adverse effects were reported.
  
  
  CONCLUSIONS
  Obturator neurolysis with 5% aqueous phenol as guided by both ultrasound and electrical stimulation can safely and effectively reduce hip adductor spasticity, thus, improving hygiene scores and patient-centered outcomes measured by the GAS in affected long-term care residents.
authors.affiliation: Shatin Cheshire Home, Hong Kong, China. Electronic address: lam_kuen@yahoo.com.hk.
authors.forename: Kuen
authors.initials: K
authors.lastname: Lam
authors.affiliation: Department of Prosthetic and Orthotic, Haven of Hope Hospital, Hong Kong, China.
authors.forename: Denis
authors.initials: D
authors.lastname: Wong
authors.affiliation: Department of Rehabilitation and Extended Care, TWGHs Wong Tai Sin Hospital, Hong Kong, China.
authors.forename: Cheuk Kwan
authors.initials: CK
authors.lastname: Tam
authors.affiliation: Department of Medicine and Geriatrics, Haven of Hope Hospital, Hong Kong, China.
authors.forename: Shu Hong
authors.initials: SH
authors.lastname: Wah
authors.affiliation: Department of Rehabilitation, Kowloon Hospital, Hong Kong, China.
authors.forename: Ma Wai Wai Jennifer
authors.initials: MW
authors.lastname: Myint
authors.affiliation: Department of Integrated Medical Services, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong, China.
authors.forename: Teresa Kim Kam
authors.initials: TK
authors.lastname: Yu
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China.
authors.forename: Kar Kui
authors.initials: KK
authors.lastname: So
authors.affiliation: Department of Medicine and Geriatrics, Haven of Hope Hospital, Hong Kong, China.
authors.forename: Gloria
authors.initials: G
authors.lastname: Cheung
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China.
authors.forename: Kai Man
authors.initials: KM
authors.lastname: Au
authors.affiliation: Department of Rehabilitation and Extended Care, TWGHs Wong Tai Sin Hospital, Hong Kong, China.
authors.forename: Ming Hung
authors.initials: MH
authors.lastname: Fu
authors.affiliation: Department of Medicine and Geriatrics, Haven of Hope Hospital, Hong Kong, China.
authors.forename: Yee Ming
authors.initials: YM
authors.lastname: Wu
authors.affiliation: Department of Integrated Medical Services, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong, China.
authors.forename: Carolyn Poey
authors.initials: CP
authors.lastname: Kng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001340:Autonomic Nerve Block / Q000379:methods*; D004311:Double-Blind Method; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D006621:Hip Joint; D006723:Hong Kong; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D009776:Obturator Nerve / Q000187:drug effects*; D010147:Pain Measurement; D010636:Phenols / Q000494:pharmacology*; D052097:Quadriceps Muscle / Q000187:drug effects* / Q000503:physiopathology; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D010636:Phenols
keywords: Hip adductor spasticity; long-term care; phenol; ultrasound-guided nerve block