Radiofrequency Thoracic Sympathectomy for Sympathetically Maintained Chronic Post-Mastectomy Pain, a Preliminary Report: 6-Month Results

Faculty of Medicine

Assiut University

Radiofrequency Thoracic Sympathectomy for Sympathetically Maintained Chronic Post-Mastectomy Pain, a Preliminary Report: 6-Month Results

Research Authors
Diab Fuad Hetta, MD*; Ashraf Amin Mohamed, MD*; Helal F. Hetta, PhD†,‡;Essam Ezzat Abd EL-Hakeem, MD§; Madona Misheal Boshra, MM¶;Mohamed Moamen El-Barody, MD**; Montaser A. Fattah Mohammad, MD*
Research Date
Research Department
Department of  Anesthesia and Intensive Care
Research File
Pain Practice - 2020 - Hetta - Radiofrequency Thoracic Sympathectomy for Sympathetically Maintained Chronic Post‐Mastectomy.pdf
Research Journal
Pain Practice, Volume 21, Issue 1, 2021 54–63
Research Member
ESSAM EZZAT ABDELHAKEEM SELEEM
Research Abstract

Abstract

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.