Thabet TS, Khedr SA Stellate Ganglion Destruction With Alcohol Versus Thermal Ablation for Chronic Post-Mastectomy Pain: A Randomized Trial. Pain Physician. 2024 Feb;27(2):E231-E238. (Original study)

BACKGROUND: Post-mastectomy pain syndrome (PMPS) is a persistent post-surgical neuropathic pain. Stellate ganglion (SG) block is used for diagnosis, prognosis, and treatment of pain syndrome.

OBJECTIVES: We aimed to evaluate the efficacy of SG destruction with alcohol versus thermal ablation for PMPS management.

STUDY DESIGN: Randomized, double-blind clinical trial.

SETTING: National Cancer Institute, Cairo University, Egypt.

METHODS: Female patients aged 20-65 years who underwent breast cancer surgery and suffered moderate to severe pain for more than 6 months were categorized equally into 2 groups. SG destruction was with ultrasound (US) guidance and C7 level confirmation by fluoroscopy either by alcohol injection in Group A or thermal ablation with a time of 60 seconds at 80ÂșC repeated twice in Group B. Follow-up was at 1, 4, 8, and 12 weeks.

RESULTS: Visual analog scale (VAS) measurements after 1, 4, 8, and 12 weeks were significantly lower than pre-procedure measurements in both groups (P value < 0.001). There was a significant reduction in VAS score after 4 and 8 weeks in Group A than in Group B (P value = 0.003 and 0.018). Oxycodone and pregabalin consumption after 4 and 8 weeks were significantly lower in Group A than in Group B. Physical health, mental health, and satisfaction scores were comparable. There were no significant complications in both groups.

LIMITATIONS: The relatively small sample size and short follow-up period are limitations to our study.

CONCLUSION: US-guided SG destruction with alcohol was more effective than thermal radiofrequency for managing acute postoperative pain by decreasing pain score, oxycodone, and pregabalin consumption, which were consumed before the block.

Discipline Area Score
Physician 5 / 7
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Comments from MORE raters

Physician rater

This is a solid well considered and executed pilot study. I agree with the authors that its primary limitations are the lack of a control arm, small sample size, and short follow-up duration. However, this study strongly suggests more robust study is warranted. In the meantime, the results should be applied to patients with mindful caution, but may have some value in some cases, even with its limitations.
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