Postmastectomy pain syndrome after preoperative stellate ganglion block: a randomized controlled trial

This study investigated the effect of preoperative ultrasound (US) guided stellate ganglion block (SGB) with bupivacaine on the frequency of post mastectomy pain syndrome (PMPS).

Eighty patients scheduled for mastectomy with axillary dissection for breast cancer were included in this randomized controlled trial. Patients were randomized into two equal groups: Group A received US guided SGB one hour before surgery using five mL of 0.5% bupivacaine and multimodal systemic analgesia, Group B (control) received multimodal systemic analgesia only. Patients were followed up for six months. PMPS was assessed using the grading system for neuropathic pain (GSNP). Postoperative opioid consumption in the first 24 hours and numeric rating scale (NRS) were documented. Patient daily activity and functional capacity were evaluated using the Eastern Cooperative Oncology Group (ECOG) score.

PMPS proportion was significantly lower in group A than group B (30% vs. 62.5%, P=0.004; 52% decrease [95% CI: 18.4%-71.8%]). Postoperative opioid consumption and NRS were significantly lower in group A as compared to group B. ECOG score was significantly higher in Group A than Group B.

Following mastectomy with axillary dissection, preoperative US guided SGB is associated with less PMPS proportion, postoperative pain and opioid consumption and better patient daily activity and functional capacity.