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Radiofrequency Thoracic Sympathectomy for Sympathetically Maintained Chronic Post-Mastectomy Pain, a Preliminary
Diab Fuad Hetta1, Ashraf Amin Mohamed1, Helal F Hetta2,3
1Department of Anesthesia and Pain Management, South Egypt Cancer Institute, Assuit University, Assiut, Egypt.
Aim:
Evaluation of the analgesic efficacy of radiofrequency thoracic sympathectomy for sympathetically maintained post-mastectomy pain syndrome (PMPS).
Methods:
Patients with PMPS randomized to Group TS (n = 33) received radiofrequency thoracic sympathectomy, and those randomized to Group Sham (n = 33) received no radiofrequency current. Postoperative pain treatment consisted of duloxetine, pregabalin, and tramadol for both groups. The outcome variables were the proportion of patients who showed >50% reduction in their VAS pain score, the pain intensity measured by VAS score, and the global perceived effect (GPE) evaluated during the 6-month follow-up period.
Results:
A significantly higher proportion of patients experienced >50% reduction in pain in Group TS (Group TS 25/30 [83.3%] vs. Group Sham 18/31 [58%], P = 0.032); the proportion of patients who experienced >50% reduction in their pain without analgesics was significantly higher in Group TS (Group TS 10/25 [40%] vs. Group Sham 0/18 [0%], P = 0.001). Furthermore, the proportion of patients treated with tramadol + duloxetine + pregabalin who experienced >50% reduction in their pain was significantly lower in Group TS (Group TS 0/25 [0%] vs. Group Sham 13/18 [75%], P = 0.001). The VAS pain score was significantly lower in Group TS at 2 weeks and at 1, 2, 3, and 6 months following the procedure. The GPE was significantly higher in Group TS (Group TS median GPE [interquartile range]) 7 [5, 7] vs. Group Sham median GPE [interquartile range]) 5 [4, 6]) P < 0.001).
Conclusions:
Radiofrequency thoracic sympathectomy for sympathetically maintained PMPS decreased VAS pain scores and reduced the need for anti-neuropathic drugs, particularly opioid medications, and provided better patient satisfaction.
