Stellate Ganglion Destruction With Alcohol Versus Thermal Ablation for Chronic Post-Mastectomy Pain: A Randomized Trial.

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 80ºC 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.