Post-mastectomy Pain Syndrome Clinical Trial
Official title:
Ultrasound-Guided Serratus Plane Block Vs Paravertebral Block For Chronic Post-mastectomy Pain.
compare the analgesic efficacy between ultrasound paraverbral block and serratus block in post mastectomy pain.
It is reported that postmastectomy pain syndrome (PMPS) is a common problem, ranging from 25%
to 60%.
The pain is localized in the axilla, medial upper arm, breast, and/or chest wall and lasting
beyond three months after surgery when all other causes of pain such as infection have been
eliminated.
The pain seriously affects the patient's mood, everyday activities, and social function and
causes heavy economic burden for the healthcare system.
Postmastectomy pain syndrome (PMPS) itself is not a specific diagnosis but rather describes a
cluster of symptoms frequently observed in breast cancer survivors following treatment.
Many patients will experience short-term nociceptive pain after breast cancer treatment.
However, with PMPS, patients frequently experience persistent neuropathic-type pain: burning,
tingling, aching, a subjective sense of "tightness" around the chest wall, or even phantom
breast or nipple pain. Neuropathic pain results from dysfunction of the peripheral nerves
caused by surgery, radiation, or neurotoxic chemotherapies.
Currently, there are a wide variety of approaches to treat this type of pain. physical
therapy has been employed as a modality to improve physical function.
As far as interventional procedures, intercostal nerve blockade, stellate ganglion blockade,
and paravertebral blockade have all been utilized with varying degrees of success.
Paraverberal blocks have superseded thoracic epidurals when it comes to choice of a regional
anaesthesia technique to provide analgesia for breast surgery.
The injection of local anaesthetic solution in the paravertebral space results in a
unilateral block, which is sensory, motor, and sympathetic. The uptake of the local
anaesthetic solution is enhanced due to the absence of fascial sheaths binding the spinal
nerves.
Another potential target for an interventional procedure for chronic pain after treatment for
breast cancer is the serratus plane. The serratus plane block is a novel ultrasound‐guided
nerve block, which is able to anesthetize the hemithorax.
The serratus plane block relies on the fact that there are branches of the intercostal nerves
following within 2 potential spaces, one superficial and one deep, surrounding the serratus
anterior muscle. The serratus anterior muscle arises as strips from the first 9 ribs and
converges posteriorly on the scapula to form the medial wall of the axilla.
The innervation of the serratus anterior muscle is via the long thoracic nerve (Bell's
nerve), and the nerve itself is covered by the fascia of the serratus anterior muscle and
lies anterior to the muscle.
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