Department of Anesthesia and Pain Management, NCI, Cairo University, Cairo. Egypt.
Pain Physician. 2018 Jul;21(4):351-362.
Breast cancer is the second most common cancer world-wide following lung cancer. Post-mastectomy pain syndrome (PMPS) is one of the chronic post-surgical pain disorders (CPSP) of neuropathic character; nearly 20-50% of patients may develop PMPS. Stellate ganglion blockade has been performed as a diagnostic, prognostic, or therapeutic intervention for different pain syndromes.
The aim of this study is to evaluate and compare the efficacy and safety of thermal versus super voltage pulsed radiofrequency (RF) application of stellate ganglion in neuropathic PMPS in cancer patients.
A prospective, double-blind, randomized, and controlled trial.
Eighty patients with PMPS after surgery for breast cancer were recruited from the pain clinic of the National Cancer Institute with pain duration of more than 6 months and less than 2 years, visual analog scale (VAS) >/= 40 mm, and not responding to oxycodone and pregabalin for at least 4 weeks. The pain had to be of positive neuropathic character, as detected by the grading system for neuropathic pain (GSNP; score of 3 or 4). The patients were allocated into 2 equally sized groups: Group A: Pulsed RF; super voltage pulsed RF was applied with a time of 360 seconds at 42º C, with a pulse width of 20 m/sec and voltage of 60-70 v. Group B: Thermal RF; thermal RF neurolysis was applied with a time of 60 seconds at 80º C, and was then was repeated twice after needle-tip rotation. Stellate ganglion RF therapy was done under fluoroscopy, integrated by ultrasound guidance. The patients were assessed for pain relief by change in VAS score, functional improvement, and the analgesic concomitant medication (oxycodone and pregabalin) consumption prior to block and at 1, 4, 12, and 24 weeks thereafter. The impact of treatment on quality of life (assessed by short-form health survey questionnaire [SF-36]) and patient function capacity (assessed by the Eastern Cooperative Oncology Group [ECOG]) were also recorded.
The percentage of patients who had successful response was significantly higher in the thermal RF group compared to the pulsed RF group at the first week and first, third, and sixth months, with significant difference in post-mastectomy pain intensity, functional improvement, and less rescue analgesia. There was no significant difference in quality of life or patient functional capacity.
A longer follow-up period may be needed for the evaluation of RF effect on PMPS.
Thermal RF of the stellate ganglion is a safe and successful treatment for PMPS. It appears to be more effective than pulsed RF of the stellate ganglion in this pain syndrome.
Cancer breast, post mastectomy pain syndrome, stellate ganglion block, radiofrequency therapy.
乳腺癌是全球范围内仅次于肺癌的第二大常见癌症。乳腺癌术后疼痛综合征（PMPS）是一种神经病理性慢性术后疼痛障碍（CPSP）；近 20-50%的患者可能会出现 PMPS。星状神经节阻滞已被用作不同疼痛综合征的诊断、预后或治疗干预措施。
本研究旨在评估和比较热射频与超电压脉冲射频（RF）应用于乳腺癌术后神经病理性 PMPS 患者星状神经节的疗效和安全性。
前瞻性、双盲、随机、对照试验。
80 例 PMPS 患者从国家癌症研究所疼痛诊所招募，这些患者均接受过乳腺癌手术，疼痛持续时间超过 6 个月且少于 2 年，视觉模拟评分（VAS）>/= 40mm，且至少 4 周未对羟考酮和普瑞巴林产生反应。疼痛必须具有阳性神经病理性特征，通过神经病理性疼痛分级系统（GSNP；评分 3 或 4）检测到。患者被分为两组，每组各 40 人：A 组：脉冲 RF；超电压脉冲 RF 应用时间为 360 秒，温度为 42°C，脉冲宽度为 20 m/sec，电压为 60-70V。B 组：热 RF；热射频神经松解应用时间为 60 秒，温度为 80°C，然后在针尖旋转后重复两次。在透视引导下，使用超声融合技术进行星状神经节 RF 治疗。通过 VAS 评分的变化、功能改善以及阻滞前和阻滞后 1、4、12 和 24 周时伴随镇痛药物（羟考酮和普瑞巴林）的消耗来评估患者的疼痛缓解情况。还记录了治疗对生活质量（通过简短健康调查问卷 [SF-36] 评估）和患者功能能力（通过东部合作肿瘤学组 [ECOG] 评估）的影响。
与脉冲 RF 组相比，热 RF 组在第 1 周、第 1、3 和 6 个月时的成功应答率显著更高，且术后疼痛强度、功能改善和镇痛药物消耗更少。两组在生活质量或患者功能能力方面无显著差异。
可能需要更长的随访时间来评估 RF 对 PMPS 的治疗效果。
星状神经节热射频是治疗 PMPS 的一种安全有效的方法。与星状神经节脉冲射频相比，它在这种疼痛综合征中似乎更有效。
乳腺癌，乳腺癌术后疼痛综合征，星状神经节阻滞，射频治疗。
