Khoury Amal L, Keane Holly, Varghese Flora, Hosseini Ava, Mukhtar Rita, Eder Suzanne E, Weinstein Philip R, Esserman Laura J
Department of Surgery, University of California San Francisco, East Bay - Highland Hospital, Oakland, CA, USA.
Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
NPJ Breast Cancer. 2021 Sep 17;7(1):123. doi: 10.1038/s41523-021-00321-w.
Post-mastectomy pain syndrome (PMPS) is a common and often debilitating condition. The syndrome is defined by chest wall pain unresponsive to standard pain medications and the presence of exquisite point tenderness along the inframammary fold at the site of the T4 and T5 cutaneous intercostal nerve branches as they exit from the chest wall. Pressure at the site triggers and reproduces the patient's spontaneous or motion-evoked pain. The likely pathogenesis is neuroma formation after injury to the T4 and T5 intercostal nerves during breast surgery. We assessed the rate of long-term resolution of post-mastectomy pain after trigger point injections (2 mL of 1:1 mixture of 0.5% bupivacaine and 4 mg/mL dexamethasone) to relieve neuropathic pain in a prospective single-arm cohort study. Fifty-two women (aged 31-92) who underwent partial mastectomy with reduction mammoplasty or mastectomy with or without reconstruction, and who presented with PMPS were enrolled at the University of California San Francisco Breast Care Center from August 2010 through April 2018. The primary outcome was a long-term resolution of pain, defined as significant or complete relief of pain for greater than 3 months. A total of 91 trigger points were treated with mean follow-up 43.9 months with a 91.2% (83/91) success rate. Among those with a long-term resolution of pain, 60 trigger points (72.3%) required a single injection to achieve long-lasting relief. Perineural infiltration with bupivacaine and dexamethasone is a safe, simple, and effective treatment for PMPS presenting as trigger point pain along the inframammary fold.
乳房切除术后疼痛综合征（PMPS）是一种常见且往往使人衰弱的病症。该综合征的定义为对标准止痛药物无反应的胸壁疼痛，以及在T4和T5肋间皮神经分支从胸壁穿出部位的乳房下皱襞处存在明显的压痛点。该部位受压会引发并重现患者的自发性疼痛或运动诱发疼痛。其可能的发病机制是乳房手术期间T4和T5肋间神经损伤后形成神经瘤。在一项前瞻性单臂队列研究中，我们评估了触发点注射（2毫升0.5%布比卡因和4毫克/毫升地塞米松的1:1混合物）以缓解神经性疼痛后乳房切除术后疼痛的长期缓解率。2010年8月至2018年4月期间，52名年龄在31 - 92岁之间、接受了部分乳房切除术加乳房缩小成形术或乳房切除术（有或无乳房重建）且患有PMPS的女性在加利福尼亚大学旧金山分校乳房护理中心入组。主要结局是疼痛的长期缓解，定义为疼痛显著或完全缓解超过3个月。总共治疗了91个触发点，平均随访43.9个月，成功率为91.2%（83/91）。在疼痛得到长期缓解的患者中，60个触发点（72.3%）只需单次注射即可实现持久缓解。布比卡因和地塞米松的神经周围浸润对于表现为乳房下皱襞处触发点疼痛的PMPS是一种安全、简单且有效的治疗方法。
