[Serious heart rate disorders following perioperative splanchnic nerve phenol nerve block]

The cardiac toxicity of phenol is known. A variety of cardiac arrhythmias has been noted, particularly after application to the skin, more rarely when used for neurolysis. We report a case of severe cardiac arrhythmia followed by circulatory arrest in a patient with pancreatic cancer which occurred a few minutes after injecting 30 ml phenol 6.66% to produce splanchnic neurolysis. Due to the cardiotoxicity of phenol, recommendations are made for the prevention of cardiac arrhythmias. When high doses of phenol are used on the skin, e.g., face peeling, applications should be over small areas with division of the phenol to each area a sufficient iv fluid load should be given, forcing diuresis with furosemide may be given, and lidocaine hydrochloride used as a prophylactic antiarrhythmic agent. In these cases, as for neurolysis (low doses of phenol), ECG monitoring is mandatory. For neurolysis, alcohol could with advantage replace phenol.