Erector spinae plane block and rhomboid intercostal block for the treatment of post-mastectomy pain syndrome

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Post-mastectomy pain syndrome (PMPS) can have multiple pain generators, including neuropathic pain and myofascial pain syndrome (MPS). Erector spinae plane (ESP) block and rhomboid intercostal block (RIB) have been used to provide anesthesia of the thorax and also for some chronic pain conditions. We describe a 43-year-old man suffering from right PMPS after right mastectomy, full axillary, and mammary lymph node dissection. We treated her with ESP blocks and RIB to reduce neuralgia and MPS: Neuropathic pain disappeared and the patient experienced only slight residual pain. The result was maintained 3 months later. This report suggests that ESP block and RIB with local anesthetic and corticosteroids with might be useful to treat a PMPS.

Related collections

Most cited references 10

Record: found
Abstract: found
Article: not found

Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).

Patrick Ginies, Nadine Attal, Eric Vicaut … (2005)

Few studies have directly compared the clinical features of neuropathic and non-neuropathic pains. For this purpose, the French Neuropathic Pain Group developed a clinician-administered questionnaire named DN4 consisting of both sensory descriptors and signs related to bedside sensory examination. This questionnaire was used in a prospective study of 160 patients presenting with pain associated with a definite neurological or somatic lesion. The most common aetiologies of nervous lesions (n=89) were traumatic nerve injury, post herpetic neuralgia and post stroke pain. Non-neurological lesions (n=71) were represented by osteoarthritis, inflammatory arthropathies and mechanical low back pain. Each patient was seen independently by two experts in order to confirm the diagnosis of neuropathic or non-neuropathic pain. The prevalence of pain descriptors and sensory dysfunctions were systematically compared in the two groups of patients. The analysis of the psychometric properties of the DN4 questionnaire included: face validity, inter-rater reliability, factor analysis and logistic regression to identify the discriminant properties of items or combinations of items for the diagnosis of neuropathic pain. We found that a relatively small number of items are sufficient to discriminate neuropathic pain. The 10-item questionnaire developed in the present study constitutes a new diagnostic instrument, which might be helpful both in clinical research and daily practice.

0 comments Cited 333 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Painful neuropathy: altered central processing maintained dynamically by peripheral input.

Gary Bennett, R Gracely, S. Lynch (1992)

We performed sensory assessments before and during diagnostic tourniquet-cuff and local anesthetic blocks in 4 patients diagnosed with reflex sympathetic dystrophy (RSD). All patients complained of mechano-allodynia; lightly touching the skin evoked an intense pain sensation. At detection levels, electrical stimuli were perceived as painful, suggesting that the mechano-allodynia was mediated by A beta low-threshold mechanoreceptor afferents. A beta-mediated allodynia was further supported by reaction time latencies to painful electrical stimuli at threshold for A-fiber activation and, in 1 patient, by differential cuff blocks which abolished A beta function and allodynia while thermal sensation (warm and cold) were preserved. Local anesthetic block of painful foci associated with previous trauma abolished mechano-allodynia, cold allodynia, and spontaneous pain in all patients and relieved the motor symptoms in 1 patient with tonic contractures of the toes. Tactile and thermal perception in the previously allodynic area was preserved. When the local anesthetic block waned, spontaneous pain, allodynia, and motor symptoms returned. We propose a model of neuropathic pain in which ongoing nociceptive afferent input from a peripheral focus dynamically maintains altered central processing that accounts for allodynia, spontaneous pain, and other sensory and motor abnormalities. Blocking the peripheral input causes the central processing to revert to normal, abolishing the symptoms for the duration of the block. The model accounts for sympathetically maintained (SMP) and sympathetically independent (SIP) pain. The peripheral input can be independent of sympathetic activity or driven completely or in part by activity in sympathetic efferents or by circulating catecholamines. The shared final common pathway may explain the common features of SMP and SIP.

0 comments Cited 107 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Corticosteroids suppress ectopic neural discharge originating in experimental neuromas.

M. Devor, P Raber, R. Lippmann (1985)

Some injured sensory fibers ending in an experimental neuroma in the rat sciatic nerve discharge spontaneously. Furthermore, many become sensitive to a range of physical and chemical stimuli. The resulting afferent barrage is thought to contribute to paresthesias and pain associated with peripheral nerve injury. We report that the development of such ectopic neuroma discharge is largely prevented when the freshly cut nerve end is treated with any of 3 commercially available corticosteroid preparations including two in depot form, triamcinolone hexacetonide (Lederspan) and triamcinolone diacetate (Ledercort), and one in soluble form, dexamethasone (Dexacort). These corticosteroids also produce a rapid and prolonged suppression of ongoing discharge in chronic neuromas that have already become active. The kinetics of corticosteroid suppression of neuroma discharge suggest a direct membrane action rather than an anti-inflammatory action.

0 comments Cited 42 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Saudi J Anaesth

Journal ID (iso-abbrev): Saudi J Anaesth

Journal ID (publisher-id): SJA

Title: Saudi Journal of Anaesthesia

Publisher: Wolters Kluwer - Medknow (India )

ISSN (Print): 1658-354X

ISSN (Electronic): 0975-3125

Publication date (Print): Oct-Dec 2020

Publication date (Electronic): 24 September 2020

Volume: 14

Issue: 4

Pages: 517-519

Affiliations

[1]Anesthesia, Intensive Care Nord and Pain Management Unit, Bellaria Hospital, Bologna, Italy

[1 ]Department of Surgery, Anesthesia and Intensive Care Section “G.B. Morgagni-Pierantoni” Hospital, Forlì, Italy

Author notes

Address for correspondence: Dr. Emanuele Piraccini, Anesthesia, Intensive Care Nord and Pain Management Unit, Bellaria Hospital, Via Altura 3, - 40139 Bologna, Italy. E-mail: drpiraccini@ 123456gmail.com

Article

Publisher ID: SJA-14-517

DOI: 10.4103/sja.SJA_203_20

PMC ID: 7796725

PubMed ID: 33447197

SO-VID: 9a751532-0325-4c3b-9661-7fd97976f603

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Erector spinae plane block and rhomboid intercostal block for the treatment of post-mastectomy pain syndrome

Read this article at

Abstract

Related collections

Irish Journal of Paramedicine

Most cited references 10

Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).

Painful neuropathy: altered central processing maintained dynamically by peripheral input.

Corticosteroids suppress ectopic neural discharge originating in experimental neuromas.

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 476

Cited by 2

Most referenced authors 85