Prajapati Laxmi, Gupta Anil Kumar, Kumar Dileep, Ramakant Pooja, Mishra Sudhir R, Yadav Ganesh, G Anjana, Deepak K
Department of Physical Medicine and Rehabilitation, King George's Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh 226003 India.
Dept. of Endocrine Surgery, King George's Medical University, 7Th Floor, Shatabdi Phase II , Shah Mina Road, Chowk, Lucknow, Uttar Pradesh 226003 India.
Indian J Surg Oncol. 2024 Dec;15(4):955-962. doi: 10.1007/s13193-024-02024-7. Epub 2024 Jul 9.
Patients with locally advanced breast cancer post-mastectomy complain of shoulder pain and restricted shoulder movement. The role of suprascapular nerve block (SSNB) in such patients needs to be explained as it may help in improving their quality of life along with pain relief. This study aims to evaluate the effect of ultrasound-guided suprascapular nerve block (SSNB) in improving shoulder motion and pain following surgery and compare its effect with exercise group. This study is a randomized controlled trial. Forty-eight patients were enrolled in the study who were referred from the endocrine surgery department, and they were randomized into two groups. Group A underwent ultrasound-guided (USG-guided) SSNB and Group B underwent an exercise program only. Each group had 24 patients who complained of pain and restricted shoulder range of motion (ROM). The outcome measures were assessed using the Mann-Whitney test for visual analog score and unpaired -test for shoulder ROM and Quick Disabilities of Arm, Shoulder, and Hand (Q-DASH) questionnaire score. All patients ( = 48) had modified radical mastectomy. The mean age was 44 ± 9.44 years and all were female gender. The improvement was noted in both the groups, but in intergroup comparison, Group A patients had significant improvement in VAS, Q-DASH score, shoulder flexion, and abduction immediately and at the 4th week follow-up ( = 0.001). No adverse effect was reported. A small sample size and no blinding reduce the strength of the study. USG-guided SSNB in post-mastectomy patients is proven to be an effective, safe, and economically accepted treatment for low-resource countries like India.
局部晚期乳腺癌乳房切除术后的患者会抱怨肩部疼痛和肩部活动受限。肩胛上神经阻滞（SSNB）在此类患者中的作用需要加以阐释，因为它可能有助于缓解疼痛并改善他们的生活质量。本研究旨在评估超声引导下肩胛上神经阻滞（SSNB）对改善术后肩部活动及疼痛的效果，并将其效果与运动组进行比较。本研究为一项随机对照试验。48例从内分泌外科转诊而来的患者被纳入研究，并随机分为两组。A组接受超声引导（USG引导）的SSNB，B组仅接受一个运动项目。每组有24例抱怨疼痛且肩部活动范围（ROM）受限的患者。使用Mann-Whitney检验评估视觉模拟评分的结果指标，使用不成对t检验评估肩部ROM以及手臂、肩部和手部快速残疾（Q-DASH）问卷评分的结果指标。所有患者（n = 48）均接受了改良根治性乳房切除术。平均年龄为44 ± 9.44岁，均为女性。两组均有改善，但在组间比较中，A组患者在VAS、Q-DASH评分、肩部前屈和外展方面在即刻及第4周随访时均有显著改善（P = 0.001）。未报告有不良反应。样本量小且未设盲降低了研究力度。在像印度这样资源匮乏的国家，超声引导下的SSNB被证明是一种对乳房切除术后患者有效、安全且经济上可接受的治疗方法。
