Department of Anesthesia and Pain Management, South Egypt Cancer Institute, Assuit University, Assiut, Egypt.
Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.
Pain Pract. 2021 Jan;21(1):54-63. doi: 10.1111/papr.12933. Epub 2020 Aug 4.
Evaluation of the analgesic efficacy of radiofrequency thoracic sympathectomy for sympathetically maintained post-mastectomy pain syndrome (PMPS).
Patients with PMPS randomized to Group TS (n = 33) received radiofrequency thoracic sympathectomy, and those randomized to Group Sham (n = 33) received no radiofrequency current. Postoperative pain treatment consisted of duloxetine, pregabalin, and tramadol for both groups. The outcome variables were the proportion of patients who showed >50% reduction in their VAS pain score, the pain intensity measured by VAS score, and the global perceived effect (GPE) evaluated during the 6-month follow-up period.
A significantly higher proportion of patients experienced >50% reduction in pain in Group TS (Group TS 25/30 [83.3%] vs. Group Sham 18/31 [58%], P = 0.032); the proportion of patients who experienced >50% reduction in their pain without analgesics was significantly higher in Group TS (Group TS 10/25 [40%] vs. Group Sham 0/18 [0%], P = 0.001). Furthermore, the proportion of patients treated with tramadol + duloxetine + pregabalin who experienced >50% reduction in their pain was significantly lower in Group TS (Group TS 0/25 [0%] vs. Group Sham 13/18 [75%], P = 0.001). The VAS pain score was significantly lower in Group TS at 2 weeks and at 1, 2, 3, and 6 months following the procedure. The GPE was significantly higher in Group TS (Group TS median GPE [interquartile range]) 7 [5, 7] vs. Group Sham median GPE [interquartile range]) 5 [4, 6]) P < 0.001).
Radiofrequency thoracic sympathectomy for sympathetically maintained PMPS decreased VAS pain scores and reduced the need for anti-neuropathic drugs, particularly opioid medications, and provided better patient satisfaction.
评估射频胸交感神经切断术治疗乳腺癌术后持续性交感神经痛（PMPS）的镇痛效果。
将 PMPS 患者随机分为 TS 组（n=33）和 Sham 组（n=33），TS 组接受射频胸交感神经切断术，Sham 组不接受射频电流。两组患者术后均采用度洛西汀、普瑞巴林和曲马多进行疼痛治疗。观察指标包括术后 6 个月内患者视觉模拟评分法（VAS）疼痛评分降幅＞50%的比例、VAS 评分疼痛强度和总体疗效评估（GPE）。
TS 组疼痛缓解＞50%的患者比例显著高于 Sham 组（25/30 [83.3%] vs. 18/31 [58%]，P=0.032）；TS 组无需镇痛药物即可缓解＞50%疼痛的患者比例显著高于 Sham 组（10/25 [40%] vs. 0/18 [0%]，P=0.001）。此外，TS 组接受曲马多+度洛西汀+普瑞巴林治疗的患者中，疼痛缓解＞50%的患者比例显著低于 Sham 组（0/25 [0%] vs. 13/18 [75%]，P=0.001）。术后 2 周及 1、2、3、6 个月时，TS 组 VAS 疼痛评分均显著低于 Sham 组。TS 组 GPE 显著高于 Sham 组[中位数 GPE（四分位间距），7（5，7）vs. 5（4，6），P＜0.001]。
射频胸交感神经切断术治疗交感神经维持性 PMPS 可降低 VAS 疼痛评分，减少抗神经病理性药物（尤其是阿片类药物）的使用，并提高患者满意度。
