Preincisional ipsilateral stellate ganglion block for acute post operative pain control in unilateral mastectomy

Objective: To evaluate the effect of preincisional ipsilateral stellate ganglion block for acute post operative pain control in unilateral mastectomy. Methodology: In a randomized clinical trial, 62 patients selected for unilateral mastectomy were recruited in Tabriz Imam Reza educational Hospital during 18-month period. They were randomly divided into two equal groups; receiving either preincisional ipsilateral stellate ganglion block using bupivacaine (study group) or without these blocks (control group). Postoperative pain was evaluated based on visual analogue scale (VAS). The total dose of analgesics were also compared between the two groups. Results: Thirty one female patients with a mean age of 48.7±7.4 (36-60) years and 31 other female patients with a mean age of 50.7±6.9 (36-60) years were enrolled in the study and control groups, respectively (p=0.292). The number of patients with decrease in postoperative pain was significantly higher in the case study group comparing with that of the control group (p<0.001). Decrease in total dose of postoperative analgesics was also significantly lower in the case study group compared with control group (P<0.001). Forty eight hours after operation, there were 15 pain-free patients in the study group with no pain-free patients in the control group. This difference was statistically significant (P<0.001). Conclusion: Based on our findings, the preincisional ipsilateral stellate ganglion block is an effective method in controlling the postoperative pain after unilateral mastectomy. This approach had also got a considerable analgesic-sparing effect.

[1]  P. Novotny,et al.  Pilot evaluation of a stellate ganglion block for the treatment of hot flashes. , 2010 .

[2]  C. P. Larson.  Millerʼs Anesthesia, 7th ed. , 2010 .

[3]  K. Slavin,et al.  Updated findings on the effects of stellate-ganglion block on hot flushes and night awakenings. , 2008, The Lancet. Oncology.

[4]  C. Loprinzi,et al.  Stellate-ganglion block: a new treatment for hot flushes? , 2008, The Lancet. Oncology.

[5]  K. Slavin,et al.  Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study. , 2008, The Lancet. Oncology.

[6]  S. Sanaie,et al.  Comparing the effect of stellate ganglion block and gabapentin on the post mastectomy pain syndrome. , 2008 .

[7]  M. Khan,et al.  Role of Stellate ganglion block in post CABG sympathetically mediated chest pain. , 2007, JPMA. The Journal of the Pakistan Medical Association.

[8]  K. Slavin,et al.  Stellate ganglion block may relieve hot flashes by interrupting the sympathetic nervous system. , 2007, Medical hypotheses.

[9]  P. Rosenberg,et al.  Preincisional paravertebral block reduces the prevalence of chronic pain after breast surgery. , 2007, Anesthesia and analgesia.

[10]  G. Feigl,et al.  Comparison of Different Injectate Volumes for Stellate Ganglion Block: An Anatomic and Radiologic Study , 2006, Regional Anesthesia & Pain Medicine.

[11]  S. Reuben.  Preventing the Development of Complex Regional Pain Syndrome after Surgery , 2004, Anesthesiology.

[12]  D. Hsu.  The Massachusetts General Hospital Handbook of Pain Management, 2nd Edition , 2002 .

[13]  R. Miguel,et al.  The effect of sentinel node selective axillary lymphadenectomy on the incidence of postmastectomy pain syndrome. , 2001, Cancer control : journal of the Moffitt Cancer Center.

[14]  S. Reuben,et al.  Surgery on the affected upper extremity of patients with a history of complex regional pain syndrome: a retrospective study of 100 patients. , 2000, The Journal of hand surgery.

[15]  A. Leach,et al.  Long-term benefits of stellate ganglion block in severe chronic refractory angina , 2000, Pain.

[16]  O. Kirvelä,et al.  Successful treatment of whiplash-type injury induced severe pain syndrome with epidural stimulation: a case report , 1999, Pain.

[17]  R. Steinberg,et al.  Sympathetically mediated pain after reduction mammoplasty: an unusual complication. , 1998, Journal of clinical anesthesia.

[18]  K. Kwekkeboom.  Postmastectomy pain syndromes. , 1996, Cancer nursing.

[19]  R. Coats,et al.  Ipsilateral stellate ganglion block effective for treating shoulder pain after thoracotomy. , 1994, Anesthesia and analgesia.

[20]  C. Vecht,et al.  Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve , 1989, Pain.

[21]  R. Cattaneo,et al.  [Anesthetic block of the stellate ganglion in the therapy of the Neri-Barre syndrome and sympathetic cervico-brachial pain]. , 1962, Minerva ortopedica.

[22]  D. Moore,et al.  The postoperative radical-mastectomy syndrome; its treatment with stellate ganglion block. , 1957, A.M.A. archives of surgery.