The effect of different compression pressure in therapy of secondary upper extremity lymphedema in women after breast cancer surgery.

This study evaluated how different levels of pressure under inelastic multi-layer bandages affect the reduction of secondary arm lymphedema and patient comfort throughout therapy. Ninety-six women with lymphedema after breast cancer treatment were randomized into three groups of 32 patients depending on level of applied pressure in compression therapy: group I (control) at 21-30 mmHg; study groups II A at 31-40 mmHg and group II B at 41-60 mmHg. All patients were treated with complex decongestive therapy (CDT) and intermittent pneumatic compression (IPC) before compression. Fixed points of bilateral arms were measured at the start (first visit), after 24 h, 7 days, and 14 days of therapy. Edema severity was measured by summary calculation. Results were presented as a relative metric coefficient of arm lymphedema (RMCAL) which is the difference between sums of circumferences of the edematous arm and the contralateral side expressed in percents. In order to evaluate the patient comfort after finishing a two-week therapy all patients assessed the level of accompanying pain using the numeric pain rating scale (NRS). At the start of therapy median arm circumference difference (RMCAL) was 18.60%, 18.51%, and 19.05% in groups I-II B, respectively. After 24 h the median RMCAL was reduced to 14.49%, 12.13%, and 12.64%. This was further reduced to 10.77%, 6.98%, and 8.48% at one week and 10.28%, 5.75%, and 7.20% in each group, respectively. There was no statistically significant difference between RMCAL values in group II A and II B throughout the therapy. In group II A (NRS = 2), applied bandages were better tolerated than in both II B (NRS = 5) and control groups (NRS = 8). These results demonstrate that inelastic multi-layer bandages applied in groups II A and II B (41-60 mmHg) led to the same reduction of swollen arm circumference with group II being better tolerated. The lowest compression (control at 21-30 mmHg) produced the smallest reduction. In addition, since the greatest reduction was seen in the first week of therapy while the second week served to maintain the reduction, compression garments may be able to be ordered after one week of therapy for more efficient patient care.