Pulsed Radiofrequency of Shoulder Individual Nerves Versus Brachial Plexus in Management of Chronic Post Mastectomy Shoulder Pain

Role of Pulsed Radiofrequency of Shoulder Individual Nerves Versus Brachial Plexus in Management of Chronic Post Mastectomy Shoulder Pain: A Prospective Randomized Controlled Study

this study aims to assess the role of pulsed radiofrequency of the brachial plexus or pulsed radiofrequency of shoulder individual nerves in the management of post-mastectomy shoulder pain.

Breast cancer is the second most common cancer world-wide following lung cancer. It afflicts about 1.7 million patients annually, of which 60% mandate surgery of the breast and/or the axilla, and nearly 20-50% of them may develop post-mastectomy pain syndrome.

Regarding pulsed RF of the brachial plexus, it is not tried up till now for shoulder pain. Since C 5,6,7 are derived from upper and middle trunks of brachial plexus, then innervation of shoulder joint can be blocked by interscalene brachial plexus block or pulsed radiofrequency . Review of literature demonstrated efficacy of PRF of brachial plexus in case studies for other conditions e.g. pain associated with a tumor involving the brachial plexus , refractory stump pain , chemotherapy-induced peripheral neuropathy of the upper limb and radiation-induced brachial plexopathy .

Inclusion Criteria:

• Age (18-65) Years.
• American Society of Anesthesiologists (ASA) physical status (II- III).
• Patients with post mastectomy shoulder pain.
• Body mass index (BMI): (20-40) kg/m2.
• Patients on maximum daily dose tramadol ( 450mg ) and still in pain

Exclusion Criteria:

• Patient refusal.
• Known sensitivity or contraindication to drugs used in the study.
• Pregnancy.
• Recent myocardial infarction.
• Hemodynamically unstable.
• Local and systemic sepsis.
• Psychiatric illness.