Combining Stellate Ganglion and T2 and T3 Radiofrequency Ablation on Post-mastectomy Complex Regional Pain Syndrome
Stellate Ganglion, Radiofrequency Ablation, Complex Regional Pain Syndromes
About this trial
This is an interventional treatment trial for Stellate Ganglion
Eligibility Criteria
Inclusion Criteria: Female patients. Type of surgery: Modified Radical Mastectomy MRM. Physical status ASA II, III. Duration of more than 6 months and less than 2 years. Moderate and severe pain (visual analog scale [VAS] ≥ 40 mm). Pain described as a refractory to strong opioids (oxycodone) and adjuvant therapy such as(pregabalin) for which more invasive interventions could be tried. Exclusion Criteria: Patient refusal. Patient with local and systemic sepsis. Local anatomical distortion. History of contralateral chest disease or pneumonectomy. Known sensitivity or contraindication to the drug used in the study. History of psychological disorders. Contraindication to regional anesthesia, e.g., pre-existing peripheral neuropathies and coagulopathy. Severe respiratory or cardiac disorders. Advanced liver or kidney disease. Pregnancy. Physical status ASA IV and Male patients.
Sites / Locations
- National Cancer InstituteRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Experimental
Radiofrequency stellate ganglion block using ultrasound guidance (SGB)
Radiofrequency thoracic (T2, T3) paravertebral block under fluoroscopic guidance
Combined radiofrequency of stellate ganglion block plus thoracic T2, T3 paravertebral block
Visualization of the C6-C7 level will be targeted under fluoroscopic posterior-anterior (PA) guidance. Skin will be infiltrated with 1% lidocaine using a 25-gauge needle. Next, the RF needle will be inserted under a trajectory approach toward the target. Then, with ultrasound guidance, using a superficial linear ultrasound probe to guide further needle penetration so that the needle-tip will lie anterior to the longus colli muscle, the exclusion of vascular structures will be confirmed by duplex. Then, 5 to 1 mL of omnipaque dye (iohexol) will be injected. Subsequently, a 100 mm length Baily RF electrode will be inserted and connected to the generator. The RF needle will be positioned alongside the stellate ganglion in the thermal RF technique. With repeated sensory and motor stimulation before RF lesioning .
Radiofrequency sympathectomy will be performed with the patient in the prone position. Under fluoroscopic guidance, the T2, T3 vertebral bodies will be identified in an anteroposterior view. For radiofrequency sympathectomy, 10 cm curved, sharp radiofrequency insulated needle with an active tip of 10 mm, needle entry will be performed, and the final placement of the needle tip will be located at the posterior third of the vertebral body in lateral view and just lateral to the body in the anteroposterior view. Once the correct position is confirmed, 0.5 to 1 ml of Omnipaque will be injected, then a 10 cm electrode will be introduced through the RF needle. Before lesioning, a sensory and motor test stimulation is performed to verify the location.
Combination between radiofrequency of stellate ganglion block and thoracic T2, T3 paravertebral block.