ABSTRACT
MISCIBILITY WITH WATER Phenol is not completely miscible with water; to obtain a homogeneous solution, an excess of water is required.1
NEUROLYSIS AND LOCAL ANESTHESIA Phenol has been widely used to treat a large number of disorders, including spasticity and chronic pain, because of its neurolytic and local anesthetic properties (5% solution). Topically applied, phenol has a lasting local anesthetic action that can affect all the layers of the skin and occurs at the same time as frosting (Box 26.1 and Figure 26.1). Phenol has been used as a surface anesthetic to perform small operations. It is neurolytic;2 it coagulates the sensitive nerve endings at the base of the epidermis and in the superficial papillary dermis. During a phenol peel, the first application of acid causes an intense burning pain that can be alleviated by prior or immediate application of something cold. After frosting, the anesthetic effect takes hold and spreads beyond the frosted area by up to a centimeter. During a phenol peel, after an initial period of analgesia, patients complain of renewed pain that they all describe differently, however. The second wave of pain is more likely to come from the rapid onset of inflammatory edema; this distends the tissues and stimulates the deeper nerve endings. This pain wears off during the first night after the procedure, when the edema is at its height and is no longer actively distending the tissues.
