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Cirocchi R, Matteucci M, Randolph J, Duro F, Properzi L, Avenia S, Amato B, Iandoli R, Tebala G, Boselli C, Covarelli P, Sapienza P. Anatomical variants of the intercostobrachial nerve and its preservation during surgery, a systematic review and meta-analysis. World J Surg Oncol 2024; 22:92. [PMID: 38605346 PMCID: PMC11007944 DOI: 10.1186/s12957-024-03374-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The anatomic variants of the intercostobrachial nerve (ICBN) represent a potential risk of injuries during surgical procedure such as axillary lymph node dissection and sentinel lymph node biopsy in breast cancer and melanoma patients. The aim of this systematic review and meta-analysis was to investigate the different origins and branching patterns of the intercostobrachial nerve also providing an analysis of the prevalence, through the analysis of the literature available up to September 2023. MATERIALS AND METHODS The protocol for this study was registered on PROSPERO (ID: CRD42023447932), an international prospective database for reviews. The PRISMA guideline was respected throughout the meta-analysis. A systematic literature search was performed using PubMed, Scopus and Web of Science. A search was performed in grey literature through google. RESULTS We included a total of 23 articles (1,883 patients). The prevalence of the ICBN in the axillae was 98.94%. No significant differences in prevalence were observed during the analysis of geographic subgroups or by study type (cadaveric dissections and in intraoperative dissections). Only five studies of the 23 studies reported prevalence of less than 100%. Overall, the PPE was 99.2% with 95% Cis of 98.5% and 99.7%. As expected from the near constant variance estimates, the heterogeneity was low, I2 = 44.3% (95% CI 8.9%-65.9%), Q = 39.48, p = .012. When disaggregated by evaluation type, the difference in PPEs between evaluation types was negligible. For cadaveric dissection, the PPE was 99.7% (95% CI 99.1%-100.0%) compared to 99.0% (95% CI 98.1%-99.7%). CONCLUSIONS The prevalence of ICBN variants was very high. The dissection of the ICBN during axillary lymph-node harvesting, increases the risk of sensory disturbance. The preservation of the ICBN does not modify the oncological radicality in axillary dissection for patients with cutaneous metastatic melanoma or breast cancer. Therefore, we recommend to operate on these patients in high volume center to reduce post-procedural pain and paresthesia associated with a lack of ICBN variants recognition.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy.
| | - Matteo Matteucci
- Department of Medicine and Surgery, University of Milan, Milan, 20122, Italy
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, 30341, USA
| | - Francesca Duro
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Luca Properzi
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Bruno Amato
- Department of Public Health, University of Naples "Federico II", Naples, 80131, Italy
| | - Ruggiero Iandoli
- Department of General Surgery, P.O Frangipane Ariano Irpino, Avellino, 83031, Italy
| | - Giovanni Tebala
- Department of Digestive and Emergency Surgery, AOSP of Terni, Terni, 05100, Italy
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Piero Covarelli
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Paolo Sapienza
- Department of Surgery, "Sapienza" University of Rome, Roma, 00161, Italy
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Al-dardery NM, Khaity AM, Albakri KA, Abdelsattar AT, Benmelouka AY, Lee T, Foppiani JA, Lin SJ. Preservation versus dissection of the intercostobrachial nerve for breast cancer surgeries: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:1003-1011. [PMID: 38333310 PMCID: PMC10849353 DOI: 10.1097/ms9.0000000000001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/04/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction This meta-analysis aimed to compare the efficacy of preservation of the intercostobrachial nerve (ICBN) versus its dissection for patients who underwent breast surgery. Methods The authors searched Web of Science, PubMed, Cochrane CENTRAL, and Scopus from inception until March 2023. Records were screened for eligible studies, and all relevant outcomes were pooled as an odds ratio (OR) with the corresponding 95% CI in the meta-analysis models using RevMan version 5.4. Results These results from 11 studies (1021 patients) favored preservation of the ICBN over its dissection in terms of anaesthesia and hypaesthesia [OR 0.50, (95% CI, 0.31-0.82); P = 0.006] and [OR 0.33, (95% CI, 0.16-0.68); P = 0.003], respectively. Whereas the overall effect favored ICBN dissection over preservation in the case of hyperaesthesia [OR 4.34, (95% CI, 1.43-13.15); P = 0.01]. Conversely, no significant variance was detected between the two groups in terms of pain [OR 0.68, (95% CI, 0.28-1.61) P = 0.38], paraesthesia [OR 0.88, (95% CI, 0.49-1.60); P = 0.68], and analgesia [OR 1.46, (95% CI, 0.05-45.69); P = 0.83]. Conclusion This meta-analysis revealed that the preservation of the ICBN has a significant effect on the disturbance of sensory parameters of hypaesthesia and anaesthesia when compared to its dissection. Further studies with larger sample sizes are recommended to precisely compare both techniques on a wider range of parameters.
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Affiliation(s)
| | | | | | | | | | | | - Jose A. Foppiani
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Samuel J. Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Nezami N, Behi A, Manyapu S, Meisel JL, Resnick N, Corn D, Prologo JD. Percutaneous CT-Guided Cryoneurolysis of the Intercostobrachial Nerve for Management of Postmastectomy Pain Syndrome. J Vasc Interv Radiol 2022; 34:807-813. [PMID: 36581196 DOI: 10.1016/j.jvir.2022.12.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the feasibility, safety, and efficacy of intercostobrachial nerve (ICBN) cryoneurolysis for pain control in patients with postmastectomy pain syndrome (PMPS). MATERIALS AND METHODS Fourteen patients with PMPS were prospectively enrolled into this clinical trial after a positive response to a diagnostic computed tomography (CT)-guided percutaneous block of the ICBN. Participants subsequently underwent CT-guided percutaneous cryoneurolysis of the same nerve and were observed on postprocedural Days 10, 90, and 180. Pain scores, quality-of-life measurements, and global impression of change values were recorded before the procedure and at each follow-up point using established validated outcome instruments. RESULTS Cryoneurolysis of the ICBN was technically successful in all 14 patients. The mean pain decreased significantly by 2.1 points at 10 days (P = .0451), by 2.4 points at 90 days (P = .0084), and by 2.9 points at 180 days (P = .0028) after cryoneurolysis. Pain interference with daily activities decreased significantly by 14.4 points after 10 days (P = .0161), by 16.2 points after 90 days (P = .0071), and by 20.7 points after 180 days (P = .0007). There were no procedure-related complications or adverse events. CONCLUSIONS Cryoneurolysis of the ICBN in patients with PMPS was technically feasible and safe and resulted in a significant decrease in postmastectomy pain for up to 6 months in this small cohort.
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Affiliation(s)
- Nariman Nezami
- Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland; Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | - Alex Behi
- Department of Biological Sciences, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia
| | - Sivasai Manyapu
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Jane L Meisel
- Division of Oncology and Hematology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Neil Resnick
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David Corn
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - J David Prologo
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
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Meng S, Platzgummer H, Loizides A, Chang KV, Gruber H. Ultrasound of Small Nerves. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:12-33. [PMID: 35135017 DOI: 10.1055/a-1495-5294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Nerve ultrasound has become an integral part of the diagnostic workup of peripheral neuropathies. Especially in the examination of small nerves, ultrasound provides superior image quality by using high frequency transducers. For a selection of small nerves, this article summarizes the local anatomy and common pathologies and offers simple instructions for determining their location with ultrasound including some cases with pathologies. This selection of nerves comprises the great auricular nerve, the supraclavicular nerves, the suprascapular nerve, the medial antebrachial cutaneous nerve, the lateral antebrachial cutaneous nerve, the palmar cutaneous branch of the median nerve, the long thoracic nerve, the intercostobrachial nerve, the posterior cutaneous nerve, the infrapatellar branch of the saphenous nerve, the medial calcaneal nerve, and the deep peroneal nerve at the ankle. Following our recommendations, these nerves can be swiftly located and tracked along their course to the site of the pathology.
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Affiliation(s)
- Stefan Meng
- Center for Anatomy and Cell Biology, Medical University of Vienna, Austria
- Radiology, Hanusch-Hospital, Vienna, Austria
| | - Hannes Platzgummer
- Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Alexander Loizides
- Department of Radiology, Innsbruck Medical University Innsbruck, Austria
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, NTUH, New Taipei City, Taiwan
| | - Hannes Gruber
- Department of Radiology, Innsbruck Medical University Innsbruck, Austria
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Pain, numbness, or both? Distinguishing the longitudinal course and predictors of positive, painful neuropathic features vs numbness after breast cancer surgery. Pain Rep 2021; 6:e976. [PMID: 34841183 PMCID: PMC8613357 DOI: 10.1097/pr9.0000000000000976] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Examining the divergence of prevalence and predictors of postsurgical numbness vs positive neuropathic symptoms gives insights into variation in clinical postoperative pain experienced by patients. Introduction: Both positive (burning, stabbing, and allodynia) and negative (numbness) neuropathic symptoms may arise after surgery but likely contribute differently to patients' postoperative pain experience. Numbness has been identified as divergent from positive neuropathic symptoms and therefore excluded from some neuropathic assessment tools (Neuropathic Pain Scale for PostSurgical patients [NeuPPS]). Objectives: In this prospective longitudinal study of patients undergoing breast surgery, we aimed to delineate the time course of numbness and its coincidence with NeuPPS and to contrast the association of surgical, psychosocial, and psychophysical predictors with the development of negative vs positive neuropathic symptoms. Methods: Patients reported surgical area sensory disturbances at 2 weeks and 3, 6, and 12 months postoperatively. Association of baseline demographic, surgical, psychosocial, and psychophysical factors with NeuPPS and numbness across time was investigated using generalized estimating equation linear and logistic regression. Results: Numbness was consistently reported by 65% of patients; positive neuropathic symptoms were less common, often decreasing over time. Neuropathic Pain scale for PostSurgical patients and numbness co-occurred in half of patients and were both associated with greater clinical pain severity and impact, younger age, axillary surgery, and psychosocial factors. More extensive surgery and chemotherapy were only associated with numbness. Conversely, other chronic pain, lower physical activity, perioperative opioid use, negative affect, and lower baseline pressure pain threshold and tolerance were only associated with NeuPPS. Patients reporting numbness alone did not endorse substantial clinical pain. Conclusions: Differentiation of predictors, prevalence, and time course of numbness vs NeuPPS in breast surgical patients revealed important distinctions, suggesting that their independent assessment is worthwhile in future studies of postsurgical pain.
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Post-Breast Surgery Pain Syndrome: Shifting a Surgical Paradigm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3720. [PMID: 34316427 PMCID: PMC8301281 DOI: 10.1097/gox.0000000000003720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
Post-mastectomy pain syndrome and the less well-described post-breast surgery pain syndrome are long-term neuropathic pain conditions that may affect more than 50% of patients after mastectomy and breast surgery. While the etiology, risk factors, and management have been reviewed in our literature, we offer here a focused outline that will gear the plastic surgeon with tools to lead a multidisciplinary, algorithmic approach to the care of patients with post-mastectomy pain syndrome/post-breast surgery pain syndrome. After reading this article, we hope the reader will have improved awareness of post-mastectomy pain syndrome/post-breast surgery pain syndrome, and thus be able to incorporate appropriate treatments and preventative steps into their primary surgical routine.
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van Tonder DJ, Lorke DE, Nyirenda T, Keough N. An uncommon, unilateral motor variation of the intercostobrachial nerve. Morphologie 2021; 106:209-213. [PMID: 34183262 DOI: 10.1016/j.morpho.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
The intercostobrachial nerve (ICBN) is commonly defined as a purely sensory nerve supplying the skin of the lateral chest wall, axilla, and medial arm. However, numerous branching patterns and distributions, including motor, have been reported. This report describes an uncommon variant of the right ICBN observed in both an 86-year-old white female cadaver and a 77-year-old white male cadaver. In both cases the ICBN presented with an additional muscular branch, termed the "medial pectoral branch", piercing and therefore innervating the pectoralis major and minor muscles. Clinically, the ICBN is relevant during surgical access to the axilla and can result in sensory deficits (persistent pain/loss of sensory function) to this region following injury. However, damage to the variation observed in these cadavers may result in additional partial motor loss to pectoralis major and minor.
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Affiliation(s)
- D J van Tonder
- Department of Anatomy and Cell Biology, College of Medicine and Health Sciences, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates.
| | - D E Lorke
- Department of Anatomy and Cell Biology, College of Medicine and Health Sciences, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates
| | - T Nyirenda
- Department of Anatomy and Cell Biology, College of Medicine and Health Sciences, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates
| | - N Keough
- Department of Anatomy and Cell Biology, College of Medicine and Health Sciences, Khalifa University, P.O. Box: 127788, Abu Dhabi, United Arab Emirates; Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
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8
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Melhem J, Amarin M, Odeh G, Al-Bustami N, Al-Lauzy H, Ayoub R. Intercostobrachial Nerve (ICBN) Preservation Versus Sacrifice in Axillary Dissection: Randomized Controlled Trial. Am J Clin Oncol 2021; 44:206-209. [PMID: 33710131 DOI: 10.1097/coc.0000000000000809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Whether to preserve or sacrifice the intercostobrachial nerves (ICBN) is a controversial issue. In this trial, we aim to assess the effects of preservation of the ICBN during axillary dissection for patients with breast cancer in terms of pain score immediately postoperatively and several hours later, need for simple analgesia and narcotics, numbness and arm swelling. MATERIALS AND METHODS This is a single-institution, single-surgeon randomized controlled trial where a sample of 48 patients with breast cancer, of various age groups, were allocated randomly to any of the 2; preservation or sacrifice categories. Postoperatively, patients were asked by a physician to fill a predesigned questionnaire to assess the studied items during hospitalization and after discharge. RESULTS Among the 48 included patients, ICBN was sacrificed in 24 patients; of which 18 patients (75%) developed numbness in the inner aspect of the arm. While in the ICBN preservation group (24 patients) only 6 patients suffered numbness (25%) with a significant P-value of 0.001. Estimated duration of surgery with ICBN preservation was 100±22.02 minutes, while it is significantly shorter in the ICBN sacrifice group (83.48±21.55). However, with regard to other variables of pain, seroma formation, need of simple analgesia and narcotics, hospital admission days and arm swelling, there was no significant difference between the 2 groups. CONCLUSION This study can conclude that preservation of ICBN during axillary dissection in patients with breast CA can save these patients' additional suffering from inner arm numbness. That is at the expense of surgery duration, around 20 minutes longer, for the surgeon to take his/her time in carefully dissecting the axilla properly without injuring these ICBN.
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Affiliation(s)
- Jamal Melhem
- Department of General Surgery.,Division of Breast Surgical Oncology
| | - Marzouq Amarin
- Department of General Surgery.,Division of Plastic Surgery
| | | | - Nadwa Al-Bustami
- Pathology, School of Medicine, University of Jordan, Amman, Jordan
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The role of ultrasound guided serratus plane block on chronic neuropathic pain after breast surgery in cancer patient. REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACIÓN 2021; 68:338-345. [PMID: 34140270 DOI: 10.1016/j.redare.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/10/2020] [Indexed: 10/21/2022]
Abstract
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.
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Jiao DC, Zhu JJ, Qin L, Guo XH, Zhao YJ, Chen XC, Wang CZ, Lu ZD, Li LF, Cui SD, Liu ZZ. Clinical practice guidelines for modified radical mastectomy of breast cancer: Chinese Society of Breast Surgery (CSBrs) practice guidelines 2021. Chin Med J (Engl) 2021; 134:895-897. [PMID: 33813515 PMCID: PMC8078368 DOI: 10.1097/cm9.0000000000001412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- De-Chuang Jiao
- Department of Breast Disease, Henan Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan 450003, China
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Dos Santos Rodrigues da Silva MJ, Lousame AA, Ferreira MLN, Fernandez Gacio M, Miranda MLC. The role of ultrasound guided serratus plane block on chronic neuropathic pain after breast surgery in cancer patient. ACTA ACUST UNITED AC 2021; 68:338-345. [PMID: 33627290 DOI: 10.1016/j.redar.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/23/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
| | - A A Lousame
- Departamento de Anestesiología y Cuidados Intensivos, Instituto Portugués de Oncología de Porto, Porto, Portugal
| | - M L N Ferreira
- Departamento de Anestesiología y Cuidados Intensivos, Instituto Portugués de Oncología de Porto, Porto, Portugal
| | - M Fernandez Gacio
- Departamento de Anestesiología y Cuidados Intensivos, Instituto Portugués de Oncología de Porto, Porto, Portugal
| | - M L C Miranda
- Departamento de Anestesiología y Cuidados Intensivos, Instituto Portugués de Oncología de Porto, Porto, Portugal
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Kaur N, Kumar R, Jain A, Saxena AK. Sensory Changes and Postmastectomy Pain Following Preservation of Intercostobrachial Nerve in Breast Cancer Surgery: a Prospective Randomized Study. Indian J Surg Oncol 2020; 12:108-113. [PMID: 33814840 DOI: 10.1007/s13193-020-01193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
Surgery for breast cancer leads to sensory changes and persistent pain in about 20-60% of patients and is usually attributed to section of the intercostobrachial nerve (ICBN). However, the opinion is divided about the benefit of preservation of ICBN. Hence, this study was designed to assess the role of preservation of ICBN on sensory changes and acute and persistent pain following mastectomy. The study was conducted on patients undergoing modified radical mastectomy for breast cancer. At the time of surgery, ICBN was sacrificed in group I (N = 29), and preserved in group II (N = 24). Patients underwent sensory assessment for touch and pain in predefined areas after surgery. They were also assessed for acute post-operative pain and persistent pain (PP) on day 30 and 90 by numeric pain rating scale. PP was also evaluated by douleur neuropathique 4 questionnaire for assessment of its neuropathic character. Preservation of ICBN resulted in significantly better preserved sensation on lateral aspect of mastectomy incision, axilla, and medial aspect of the arm. Frequency and severity of acute post-operative pain were similar between the two groups. However, PP was significantly reduced in ICBN preserved group. At 3 months, 31% patients in group I and 12.5% in group II had clinically significant pain (p = 0.024). DN 4 assessment showed neuropathic character of pain in 20.6% and 8.33% in group I and II respectively. In our study, preservation of ICBN resulted in reduced rates of sensory loss and persistent neuropathic pain.
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Affiliation(s)
- Navneet Kaur
- Department of Surgery, UCMS & GTB Hospital University of Delhi, Dilshad Garden, Delhi, 110095 India
| | - Ram Kumar
- Department of Surgery, UCMS & GTB Hospital University of Delhi, Dilshad Garden, Delhi, 110095 India
| | - Ayush Jain
- Department of Surgery, UCMS & GTB Hospital University of Delhi, Dilshad Garden, Delhi, 110095 India
| | - Ashok Kumar Saxena
- Department of Anesthesia and critical care, UCMS & GTB Hospital, Delhi, India
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Siqueira TC, Frágoas SP, Pelegrini A, de Oliveira AR, da Luz CM. Factors associated with upper limb dysfunction in breast cancer survivors. Support Care Cancer 2020; 29:1933-1940. [PMID: 32808138 DOI: 10.1007/s00520-020-05668-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze factors associated with upper limb dysfunction in women after breast cancer treatment. METHODOLOGY A cross-sectional study with 233 women over 18 years of age diagnosed with breast cancer and undergoing at least one cancer treatment (surgery and/or adjuvant treatment). Sociodemographic, anthropometric, and cancer treatment data were collected, as well as current physical and functional complications. Changes in breast tenderness and intercostobrachial nerve pathway, winged scapula, pain, cicatricial adherence, and lymphedema were evaluated by physical examination (inspection and palpation). Upper limb dysfunction was assessed using the DASH questionnaire. Chi-square test and logistic regression were used to verify possible associations between upper limb dysfunction and other variables. RESULTS The results showed that 55.4% of women had some level of upper limb dysfunction. Evaluating treatment conditions, lymphadenectomy, lymphedema, presence of pain, and intercostobrachial nerve injury were associated with some level of upper limb dysfunction in the crude analysis. The adjusted analysis showed that only upper limb dysfunction remained associated with intercostobrachial nerve injury, regardless of age and body mass index. CONCLUSION Upper limb dysfunction is frequent after breast cancer treatment and may be associated with neuropathies due to changes in the intercostobrachial nerve pathway.
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Affiliation(s)
- Thais Cristina Siqueira
- Physiotherapy Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Pascoal Simone, 358, Coqueiros, Florianópolis, SC, 88080-350, Brazil
| | - Simone Pedrozo Frágoas
- Physiotherapy Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Pascoal Simone, 358, Coqueiros, Florianópolis, SC, 88080-350, Brazil
| | - Andreia Pelegrini
- Human Movement Sciences Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Ana Rosa de Oliveira
- Mastology Service, Carmela Dutra Maternity, Santa Catarina State Department of Health, Florianópolis, Brazil
| | - Clarissa Medeiros da Luz
- Physiotherapy Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Pascoal Simone, 358, Coqueiros, Florianópolis, SC, 88080-350, Brazil.
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Mustonen L, Vollert J, Rice ASC, Kalso E, Harno H. Sensory profiles in women with neuropathic pain after breast cancer surgery. Breast Cancer Res Treat 2020; 182:305-315. [PMID: 32458104 PMCID: PMC7297844 DOI: 10.1007/s10549-020-05681-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/09/2020] [Indexed: 12/11/2022]
Abstract
Purpose We performed a detailed analysis of sensory function in patients with chronic post-surgical neuropathic pain (NP) after breast cancer treatments by quantitative sensory testing (QST) with DFNS (German Research Network on Neuropathic Pain) protocol and bed side examination (BE). The nature of sensory changes in peripheral NP may reflect distinct pathophysiological backgrounds that can guide the treatment choices. NP with sensory gain (i.e., hyperesthesia, hyperalgesia, allodynia) has been shown to respond to Na+-channel blockers (e.g., oxcarbazepine). Methods 104 patients with at least “probable” NP in the surgical area were included. All patients had been treated for breast cancer 4–9 years ago and the handling of the intercostobrachial nerve (ICBN) was verified by the surgeon. QST was conducted at the site of NP in the surgical or nearby area and the corresponding contralateral area. BE covered the upper body and sensory abnormalities were marked on body maps and digitalized for area calculation. The outcomes of BE and QST were compared to assess the value of QST in the sensory examination of this patient group. Results Loss of function in both small and large fibers was a prominent feature in QST in the area of post-surgical NP. QST profiles did not differ between spared and resected ICBN. In BE, hypoesthesia on multiple modalities was highly prevalent. The presence of sensory gain in BE was associated with more intense pain. Conclusions Extensive sensory loss is characteristic for chronic post-surgical NP several years after treatment for breast cancer. These patients are unlikely to respond to Na+-channel blockers.
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Affiliation(s)
- L Mustonen
- Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, Pain Clinic, University of Helsinki and Helsinki University Hospital, P.O. Box 140, 00029 HUS, Helsinki, Finland. .,Neurocenter, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
| | - J Vollert
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK.,Neurophysiology, Center of Biomedicine and Medical Technology Mannheim CBTM, Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
| | - A S C Rice
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
| | - E Kalso
- Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, Pain Clinic, University of Helsinki and Helsinki University Hospital, P.O. Box 140, 00029 HUS, Helsinki, Finland
| | - H Harno
- Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, Pain Clinic, University of Helsinki and Helsinki University Hospital, P.O. Box 140, 00029 HUS, Helsinki, Finland.,Neurocenter, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
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15
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Weber G, Saad K, Awad M, Wong TH. Case Report Of Cryoneurolysis For The Treatment Of Refractory Intercostobrachial Neuralgia With Postherpetic Neuralgia. Local Reg Anesth 2019; 12:103-107. [PMID: 31802935 PMCID: PMC6830355 DOI: 10.2147/lra.s223961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/18/2019] [Indexed: 01/10/2023] Open
Abstract
Postherpetic neuralgia is a common and potentially debilitating neuropathic pain condition. Current pharmacologic therapy can be inadequate and intolerable for patients. We present a case of a gentleman with refractory postherpetic neuralgia in the intercostobrachial nerve distribution that was successfully treated with cryoneurolysis/cryoanalgesia therapy.
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Affiliation(s)
- Garret Weber
- Department of Anesthesiology, New York Medical College, Valhalla, NY, USA
| | - Kenneth Saad
- Department of Anesthesiology, New York Medical College, Valhalla, NY, USA
| | - Motaz Awad
- Department of Anesthesiology, New York Medical College, Valhalla, NY, USA
| | - Tiffany H Wong
- Department of Anesthesiology, New York Medical College, Valhalla, NY, USA
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16
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What makes surgical nerve injury painful? A 4-year to 9-year follow-up of patients with intercostobrachial nerve resection in women treated for breast cancer. Pain 2019; 160:246-256. [PMID: 30234699 PMCID: PMC6319585 DOI: 10.1097/j.pain.0000000000001398] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nerve injury during breast cancer surgery can cause neuropathic pain (NP). It is not known why some, but not all, patients develop chronic postsurgical neuropathic pain (CPSNP) after the same nerve injury. In this study, we examined 251 breast cancer survivors with surgeon-verified intercostobrachial nerve resection to identify factors that associate with CPSNP. The patients were recruited from a previous study of 1000 women treated for breast cancer in 2006 to 2010. This enabled us to analyze preoperative factors that associate with future CPSNP. The patients were re-examined in 2014 to 2016 to diagnose CPSNP using the revised NP diagnostic criteria. Preoperative assessments were pain in the area to be operated on, any chronic pain condition, depressive symptoms, anxiety, sleep, and experimental cold pain sensitivity using the cold pressor test (CPT). Follow-up assessments were CPT, psychological factors, sleep, any chronic pain, and basic laboratory tests. One hundred thirty-seven (55%) patients with intercostobrachial nerve resection fulfilled CPSNP diagnostic criteria after 4 to 9 years. Of them, 30 patients (22%) had moderate to severe pain in self-reports and 86 (63%) presented moderate to severe evoked pain at examination. Preoperative pain in the surgical area, other chronic pains, and breast-conserving surgery were associated with future CPSNP. Other chronic pains, increased psychological burden, and insomnia, both before surgery and at the follow-up, were associated with CPSNP. Preoperative CPT did not associate with future CPSNP. Patients with established CPSNP showed increased pain sensitivity in CPT and higher levels of inflammatory markers, suggesting that central sensitization and inflammation may associate with the maintenance of CPSNP.
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17
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The arrival of axilla conserving therapy (ACT). Is this the second revolution in locoregional management of breast cancer care? Radiother Oncol 2018; 128:591-592. [PMID: 29482843 DOI: 10.1016/j.radonc.2018.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 02/07/2018] [Accepted: 02/09/2018] [Indexed: 11/20/2022]
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Intercostobrachial Neuralgia After Axillary Surgery for Hidradenitis Suppurativa. Dermatol Surg 2018; 44:1470-1472. [PMID: 29293110 DOI: 10.1097/dss.0000000000001458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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[Impact of the preservation of the branches of intercostobrachial nerve on the quality of life of patients operated for a breast cancer]. Bull Cancer 2017; 104:858-868. [PMID: 28917551 DOI: 10.1016/j.bulcan.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 11/21/2022]
Abstract
AIM The aim of this study was to assess the impact of the preservation of the intercostobrachial nerve on the quality of life of patients operated for breast cancer. METHODS This study was ancillary to cost comparison study of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. It was a prospective multicenter, observational, non-randomized study. The quality of life was assessed using two questionnaires: QLQ-C30 and specific module QLQ-BR23 Surveys have been performed before initiation of surgery, one week, and 1 month, 8 months and 12 months after discharge from hospitalization for the first surgical procedure. RESULTS Five hundred and seventy-eight patients with preservation of intercostobrachial nerve without axillary lymph node dissection (C- P+), 85 without preservation of nerve and axillary lymph node dissection (C+P-) and 57 with preservation of nerve and axillary lymph node dissection (C+P+) have been included in the study. The changing arm symptoms score was significantly different during follow-up between the three groups (P<0.001). This difference between the two groups C- P+ and C+P+ was significant clinically at one week [16.9, IC95%: 11.9 to 22 (P<0.01)], and persisted for up to 12 months [9.9, IC95%: 3.2 à16.6 (P=0.022)]. There was no difference between the group C+P- and C+P+. Results for physical functioning score were similar. CONCLUSION Preservation of the intercostobral nerve is not associated with better quality of life. Only axillary lymph node dissection has an impact on quality of life.
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Andersen KG, Duriaud HM, Kehlet H, Aasvang EK. The Relationship Between Sensory Loss and Persistent Pain 1 Year After Breast Cancer Surgery. THE JOURNAL OF PAIN 2017; 18:1129-1138. [PMID: 28502878 DOI: 10.1016/j.jpain.2017.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/07/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
Moderate to severe persistent pain after breast cancer surgery (PPBCS) affects 10 to 20% of the patients. Sensory dysfunction is often concomitantly present suggesting a neuropathic pain state. The relationship between various postoperative pain states and sensory dysfunction has been examined using quantitative sensory testing (QST), but only 2 smaller studies have examined PPBCS and sensory dysfunction in the surgical area. The purpose of this prospective study was to assess the relative importance of sensory function and PPBCS. QST consisted of sensory mapping, tactile detection threshold, mechanical pain threshold, and thermal thresholds. Two hundred ninety patients were enrolled and results showed that 38 (13%) had moderate to severe pain and 246 (85%) had hypoesthesia in the surgical area 1 year after surgery. Increased hypoesthesia areas were associated with pain at rest as well as during movement (P = .0001). Pain during movement was associated with a side-to-side difference of 140% (P = .001) for tactile detection threshold and 40% (P = .01) for mechanical pain threshold as well as increased thermal thresholds in the axilla (P > .001). Logistic regression models controlling for confounders showed larger areas of hypoesthesia as a significant risk factor, odds ratio 1.85 per 100 cm2 for pain at rest and odds ratio 1.36 per 100 cm2 for pain during movement. PERSPECTIVE PPBCS is associated with increasing areas of hypoesthesia as well as intraoperative nerve preservation. Thus, we hypothesize that PPBCS is associated with an interaction between a peripheral nociceptive drive in macroscopically preserved nerves and the central nervous system causing PPBCS as well as hypoesthesia. QST may identify patients suitable for intervention.
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Affiliation(s)
- Kenneth Geving Andersen
- Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Breast Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Helle Molter Duriaud
- Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eske Kvanner Aasvang
- Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Anesthesiological Department, the Abdominal Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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21
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Meretoja TJ, Andersen KG, Bruce J, Haasio L, Sipilä R, Scott NW, Ripatti S, Kehlet H, Kalso E. Clinical Prediction Model and Tool for Assessing Risk of Persistent Pain After Breast Cancer Surgery. J Clin Oncol 2017; 35:1660-1667. [PMID: 28524782 DOI: 10.1200/jco.2016.70.3413] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Persistent pain after breast cancer surgery is a well-recognized problem, with moderate to severe pain affecting 15% to 20% of women at 1 year from surgery. Several risk factors for persistent pain have been recognized, but tools to identify high-risk patients and preventive interventions are missing. The aim was to develop a clinically applicable risk prediction tool. Methods The prediction models were developed and tested using three prospective data sets from Finland (n = 860), Denmark (n = 453), and Scotland (n = 231). Prediction models for persistent pain of moderate to severe intensity at 1 year postoperatively were developed by logistic regression analyses in the Finnish patient cohort. The models were tested in two independent cohorts from Denmark and Scotland by assessing the areas under the receiver operating characteristics curves (ROC-AUCs). The outcome variable was moderate to severe persistent pain at 1 year from surgery in the Finnish and Danish cohorts and at 9 months in the Scottish cohort. Results Moderate to severe persistent pain occurred in 13.5%, 13.9%, and 20.3% of the patients in the three studies, respectively. Preoperative pain in the operative area ( P < .001), high body mass index ( P = .039), axillary lymph node dissection ( P = .008), and more severe acute postoperative pain intensity at the seventh postoperative day ( P = .003) predicted persistent pain in the final prediction model, which performed well in the Danish (ROC-AUC, 0.739) and Scottish (ROC-AUC, 0.740) cohorts. At the 20% risk level, the model had 32.8% and 47.4% sensitivity and 94.4% and 82.4% specificity in the Danish and Scottish cohorts, respectively. Conclusion Our validated prediction models and an online risk calculator provide clinicians and researchers with a simple tool to screen for patients at high risk of developing persistent pain after breast cancer surgery.
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Affiliation(s)
- Tuomo J Meretoja
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Kenneth Geving Andersen
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Julie Bruce
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Lassi Haasio
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Reetta Sipilä
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Neil W Scott
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Samuli Ripatti
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Henrik Kehlet
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Eija Kalso
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
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Lindau ST, Abramsohn EM, Baron SR, Florendo J, Haefner HK, Jhingran A, Kennedy V, Krane MK, Kushner DM, McComb J, Merritt DF, Park JE, Siston A, Straub M, Streicher L. Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist. CA Cancer J Clin 2016; 66:241-63. [PMID: 26784536 PMCID: PMC4860140 DOI: 10.3322/caac.21337] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 11/13/2015] [Accepted: 11/18/2015] [Indexed: 12/15/2022] Open
Abstract
Answer questions and earn CME/CNE Sexual concerns are prevalent in women with cancer or cancer history and are a factor in patient decision making about cancer treatment and risk-reduction options. Physical examination of the female cancer patient with sexual concerns, regardless of the type or site of her cancer, is an essential and early component of a comprehensive evaluation and effective treatment plan. Specialized practices are emerging that focus specifically on evaluation and treatment of women with cancer and sexual function problems. As part of a specialized evaluation, oncologists and their patients should expect a thorough physical examination to identify or rule out physical causes of sexual problems or dysfunction. This review provides oncology professionals with a description of the physical examination of the female cancer patient with sexual function concerns. This description aims to inform anticipatory guidance for the patient and to assist in interpreting specialists' findings and recommendations. In centers or regions where specialized care is not yet available, this review can also be used by oncology practices to educate and support health care providers interested in expanding their practices to treat women with cancer and sexual function concerns. CA Cancer J Clin 2016;66:241-263. © 2016 American Cancer Society.
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Affiliation(s)
- Stacy Tessler Lindau
- Director, Program in Integrative Sexual Medicine for Women and Girls With Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
- Associate Professor, Department of Medicine-Geriatrics, University of Chicago, Chicago, IL
- MacLean Center on Clinical Medical Ethics, University of Chicago, Chicago, IL
- Associate Professor, Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Emily M Abramsohn
- Researcher and Project Manager, Program in Integrative Sexual Medicine for Women and Girls With Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Shirley R Baron
- Assistant Professor, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Clinical Associate, Program in Integrative Sexual Medicine for Women and Girls With Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Judith Florendo
- Doctor of Physical Therapy, Florendo Physical Therapy, Chicago, IL
- Clinical Associate, Program in Integrative Sexual Medicine for Women and Girls with Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Hope K Haefner
- Professor, Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI
| | - Anuja Jhingran
- Professor, Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vanessa Kennedy
- Assistant Professor, Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, CA
| | - Mukta K Krane
- Assistant Professor, Department of Surgery, University of Washington, Seattle, WA
| | - David M Kushner
- Director, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jennifer McComb
- Assistant Clinical Professor, The Family Institute at Northwestern University, Evanston, IL
| | - Diane F Merritt
- Professor, Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, WA University School of Medicine, St. Louis, MO
| | - Julie E Park
- Associate Professor, Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Amy Siston
- Clinical Associate, Department of Psychiatry and Behavioral Neurosciences, University of Chicago, Chicago, IL
| | - Margaret Straub
- Physician's Assistant, Radiation Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Lauren Streicher
- Associate Professor, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL
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Ultrasound-Guided Intercostobrachial Nerve Block for Intercostobrachial Neuralgia in Breast Cancer Patients: A Case Series. PM R 2016; 8:273-7. [DOI: 10.1016/j.pmrj.2015.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 10/01/2015] [Accepted: 10/15/2015] [Indexed: 11/23/2022]
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Andersen KG, Duriaud HM, Aasvang EK, Kehlet H. Association between sensory dysfunction and pain 1 week after breast cancer surgery: a psychophysical study. Acta Anaesthesiol Scand 2016; 60:259-69. [PMID: 26446738 DOI: 10.1111/aas.12641] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 08/24/2015] [Accepted: 09/05/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Breast cancer patients treated with axillary lymph node dissection (ALND) have a higher risk of both acute and persistent pain than those treated with sentinel lymph node biopsy (SLNB). This could be attributed to a higher risk of nerve injury with ALND. We hypothesized that (1) pain patients have more pronounced sensory dysfunction than pain-free patients, (2) ALND have more sensory dysfunction and pain than SLNB patients and (3) patients with preserved intercostobrachial nerve (ICBN) preservation have less sensory dysfunction compared to a sectioned ICBN. METHODS Twenty-seven patients treated with ALND and 27 with SLNB examined with a standardized Quantitative Sensory Testing (QST) protocol, including sensory mapping, mechanical and thermal thresholds, as well as recording intraoperative ICBN handling and pain status 1 week post-operative. RESULTS The area of cold hypoaesthesia was significantly associated with movement-related pain (P = 0.004), with a similar tendency for warmth (P = 0.018) and brush (P = 0.030) hypoaesthesia areas. 14 (26%) of the patients had moderate/severe pain at rest and 13 (24%) during movement without differences between ALND and SLNB, but ALND was associated with more sensory dysfunction than SLNB. Patients with sectioned ICBN reported lower pain intensity than those with preserved ICBN (P = 0.005), but without differences in sensory dysfunction. CONCLUSION Pain was increased in patients having larger areas of hypoaesthesia and reduced in patients where ICBN-section was done. Sensory dysfunction was related to extent of axillary surgery, but not with ICBN handling. Our data suggest that acute pain after breast cancer surgery may be related to nerve injury.
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Affiliation(s)
- K. G. Andersen
- Section for Surgical Pathophysiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- Department of Breast Surgery; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - H. M. Duriaud
- Section for Surgical Pathophysiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - E. K. Aasvang
- Section for Surgical Pathophysiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - H. Kehlet
- Section for Surgical Pathophysiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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26
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Ahmed M, Cook LJ, Douek M. Preservation of the intercostobrachial nerve during axillary node clearance for breast cancer. Hippokratia 2014. [DOI: 10.1002/14651858.cd011229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Muneer Ahmed
- King's College London; Department of Research Oncology; Great Maze Pond London UK SE1 9RT
| | - Lorna J Cook
- King's College London; Department of Research Oncology; Great Maze Pond London UK SE1 9RT
| | - Michael Douek
- King's College London; Department of Research Oncology; Great Maze Pond London UK SE1 9RT
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27
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Abstract
Purpose The present study aimed to measure the thickness of the subcutaneous adipose tissue (SAT) at the site of the surgical incision for axillary lymph node dissection (ALND) and to record potential anatomical variations in the medial cutaneous nerve of the arm (MCNA), the intercostobrachial nerve (ICBN), the lateral thoracic vein (LTV), the lateral thoracic artery (LTA) and the pectoral muscle pedicle (PMP), considering that some details of the anatomy of these structures within the axilla are still unclear. Methods A prospective study was conducted in 100 consecutive patients with breast cancer who underwent ALND as part of surgical treatment. The anatomy of the dissected axilla was video recorded. Results The SAT thickness ranged from 8 mm to 60 mm, with an average thickness of 25.9 mm. A positive correlation was observed between the SAT thickness and the body mass index (BMI) of the evaluated patients (r = 0.68; p < 0.0001). The MCNA was the anatomical structure that was least commonly observed in the axilla (22% of cases), while the PMP was the most constant element, identified in 100% of cases. All of the studied anatomical structures observed within the axilla showed variation in at least one of the aspects analyzed, i.e., the point of entry and exit, path, number and location of divisions or branches. Conclusion The present study demonstrated wide variation in thickness of the SAT overlying the axilla and identified the existence of broad normative anatomical variation of the axilla. Electronic supplementary material The online version of this article (doi:10.1186/2193-1801-3-306) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emerson Wander Silva Soares
- Biological Science and Health Center, Western Paraná State University, (Universidade Estadual do Oeste do Paraná, UNIOESTE), Cascavel, Paraná, Brazil ; Department of Surgical Oncology, Study and Treatment Cancer Center of Western Paraná, (União Oeste Paranaense de Estudos e Combate ao Câncer, UOPECCAN), Cascavel, Paraná, Brazil
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