Availability of Ethanol for Alcohol Neurolysis
Yes, absolute ethanol for alcohol neurolysis is available in vials. 1
Formulation and Availability
According to consensus guidelines on endoscopic ultrasonography-guided celiac plexus neurolysis (EUS-CPN), absolute ethanol is the standard neurolytic agent used for this procedure 1. The guidelines specifically recommend:
- 10-20 mL of absolute ethanol for EUS-CPN procedures
- 1-2 mL of ethanol for EUS-guided celiac ganglia neurolysis (EUS-CGN) 1
The Expert Consensus Guidelines for Stocking of Antidotes in Hospitals that provide emergency care lists ethanol as an available antidote in 95% concentration, which requires compounding at use 1. While this reference doesn't specifically address neurolysis applications, it confirms that medical-grade ethanol is available in healthcare settings.
Administration Considerations
When performing alcohol neurolysis:
- Absolute ethanol is injected until an echogenic cloud is seen to spread sufficiently under EUS guidance 1
- For celiac ganglia neurolysis, injection continues until the ganglion becomes hyperechoic and difficult to visualize 1
- The volume used is significantly lower in EUS-CGN than in EUS-CPN as demonstrated in randomized studies 1
Alternative Agents
For patients with alcohol intolerance due to aldehyde dehydrogenase deficiency:
- Phenol may be used as an alternative neurolytic agent 1
- Studies show no significant difference in positive response rates between phenol and ethanol 1
- Both 65% ethanol and 5-12% phenol have been used for peripheral nerve blockade 2
Clinical Applications
Alcohol neurolysis is used in various clinical scenarios:
- Pain management in unresectable upper abdominal cancer, particularly pancreatic cancer 1
- Muscle spasticity treatment in stroke, spinal trauma, multiple sclerosis, and cerebral palsy 2, 3
- Intrathecal neurolytic blocks using 95% alcohol 4
Safety Considerations
When using ethanol for neurolysis:
- Concentrations of 5% or lower generally do not cause visible cellular injury within 30 minutes 5
- Higher concentrations (10% or more) can quickly cause membrane damage and cell death 5
- Common adverse events include transient diarrhea (0-23.4%), transient pain exacerbation (0-36%), and transient hypotension (0-12.5%) 1
- Careful patient positioning is required as alcohol is hypobaric compared to cerebrospinal fluid 4
The availability of absolute ethanol in vials makes it a practical option for neurolytic procedures in appropriate clinical settings, with established guidelines for its use in pain management.