Papel del bloqueo ecoguiado del plano del músculo serrato en el dolor neuropático crónico tras una cirugía de mama en una paciente de cáncer / The role of ultrasound guided serratus plane block on chronic neuropathic pain after breast surgery in cancer patient

Antecedentes: El cáncer de mama es el tipo de cáncer más frecuente entre las mujeres. Entre las secuelas de su tratamiento se encuentra el dolor neuropático crónico tras la cirugía de mama (CNPBS). El tratamiento del dolor es difícil y consiste normalmente en una terapia farmacológica aunque, sin embargo, los estudios recientes han defendido el uso de técnicas locorregionales como adyuvantes. El bloqueo del plano del músculo serrato (SPB) ha surgido recientemente como herramienta potencial para controlar el CNPBS. El objetivo de este estudio es evaluar la eficacia y papel potencial del SPB ecoguidado en el CNPBS. Métodos: Se realizó un análisis retrospectivo en 30 pacientes con CNPBS refractario a terapia farmacológica, sometidas a SPB entre 2017 y 2019. Se analizaron los parámetros siguientes: dolor basal, dolor a las 24 horas, una semana y un mes. Se aplicó la prueba de Mann-Whitney. Se consideró significación estadística al nivel de p < 0,05. Todos los análisis estadísticos se realizaron utilizando SPSS 20. Resultados: Tres pacientes fueron excluidas. Transcurridas 24 horas, reportamos mejora del dolor (al menos una reducción del 30% sobre la puntuación del dolor basal) en 20 pacientes, y en 12 transcurrida una semana. Al cabo de un mes, 22 pacientes habían experimentado mejora, de los cuales: 11 mejoraron sin ajuste terapéutico, 11 pacientes mejoraron con ajuste terapéutico (ocho con monoterapia de gabapentinoides, tres con introducción de politerapia), y cinco pacientes no experimentaron mejora. Conclusión: Nuestro estudio demostró que SPB es una alternativa válida para el tratamiento de CNPBS cuando la terapia farmacológica se ha mostrado insuficiente, no habiéndose reportado efectos secundarios. Son necesarios estudios aleatorios para evaluar la magnitud de SPB en CNPBS, e identificar a los pacientes que más se beneficiarían de SPB.(AU)

Background: Breast cancer is the most commonly occurring cancer among women. Among its treatment sequelae is chronic neuropathic pain after breast surgery (CNPBS). Pain management is difficult and classicaly consists in a pharmacological approach, however recent studies have advocated the use of locoregional techniques as adjuvants. Serratus plane block (SPB) has recently emerged as a potential tool for the control of CNPBS. This study aims to evaluate the efficacy and potencial role of the ultrasound-guided SPB on CNPBS. Methods: A retrospective analysis was performed on 30 patients with CNPBS refractory to drug therapy, who underwent SPB between 2017-2019. The following parameters were analyzed: basal pain, pain at 24 hours, 1 week and at 1 month. The Mann-Whitney test was applied. Statistical significance was considered at the level of p < 0.05. All statistical analysis was performed with SPSS 20. Results: 3 patients were excluded. At 24 hours, we report pain improvement (at least 30% reduction on basal pain score) on 20 patients and after 1 week on 12. At 1 month after, 22 patients had improved, from these: 11 improved with no therapeutic adjustment; 11 patients improved with therapeutic adjustment (8 in gabapentinoid monotherapy, 3 with introduction of polytherapy). 5 patients didn’t improve. Conclusión: Our study demonstrated SPB as a valid alternative for CNPBS management when pharmacologic therapy has been proven insufficient, with no side effects reported. Randomized studies are needed to assess the magnitude of SPB on CNPBS and to identify the patients who benefit the most from SPB.(AU)

The role of ultrasound guided serratus plane block on chronic neuropathic pain after breast surgery in cancer patient.

BACKGROUND: Breast cancer is the most commonly occurring cancer among women. Among its treatment sequelae is chronic neuropathic pain after breast surgery (CNPBS). Pain management is difficult and classicaly consists in a pharmacological approach, however recent studies have advocated the use of locoregional techniques as adjuvants. Serratus plane block (SPB) has recently emerged as a potential tool for the control of CNPBS. This study aims to evaluate the efficacy and potencial role of the ultrasound-guided SPB on CNPBS. METHODS: A retrospective analysis was performed on 30 patients with CNPBS refractory to drug therapy, who underwent SPB between 2017-2019. The following parameters were analyzed: basal pain, pain at 24 h, 1 week and at 1 month. The Mann-Whitney test was applied. Statistical significance was considered at the level of p < 0.05. All statistical analysis was performed with SPSS 20. RESULTS: 3 patients were excluded. At 24 h, we report pain improvement (at least 30% reduction on basal pain score) on 20 patients and after 1 week on 12. At 1 month after, 22 patients had improved, from these: 11 improved with no therapeutic adjustment; 11 patients improved with therapeutic adjustment (8 in gabapentinoid monotherapy, 3 with introduction of polytherapy). 5 patients didn't improve. CONCLUSION: Our study demonstrated SPB as a valid alternative for CNPBS management when pharmacologic therapy has been proven insufficient, with no side effects reported. Randomized studies are needed to assess the magnitude of SPB on CNPBS and to identify the patients who benefit the most from SPB.

The efficacy of the ganglion impar block in perineal and pelvic cancer pain.

BACKGROUND: Visceral pain conducted by sympathetic fibers with pelvic and perineal origin can be treated using ganglion impar (GIB) or Walters' block in a simple and effective manner. This article aims to evaluate the effectiveness, security, and performance difficulty of GIB in patients with pelvic and perineal oncological pain. METHODS: A retrospective study between January 2016 and August 2017. Patients with poorly controlled pelvic oncological pain and patients experimenting opioid side effects in which GIB was performed ambulatory were included. Prognostic GIB was performed, under echographic and fluoroscopic control, with local anesthetic and corticoid. The neurolytic block was performed under fluoroscopic guidance. The technique was performed by the same anesthetist with pain management competence. For statistical analysis, Microsoft Excel 2013® and IBM SPSS Statistics version 22.0 were used. RESULTS: Fifteen patients were included. One patient was excluded. A statistical significant basal pain score reduction was observed ((median of the verbal numerical scale (VNS) 7 (p25 = 7; p75 = 8)) compared with 72 h median VNS 4 ((p25 = 3; p75 = 5.3) p = 0.001, and 3 months (median VNS 4 (p25 = 3, p75 = 7)) p = 0.003 after the procedure. Regarding morphine consumption, a statistically significant reduction was observed 3 months after GIB performance (p = 0.012). DISCUSSION/CONCLUSION: GIB is a safe and easy-to-perform technique achieving satisfactory and statistically significant results, regarding pain control improvement and opioid consumption reduction in patients which meet selection criteria. Prospective, randomized studies with more patients are needed for further conclusions.