A Study to Assess the Effects of Intercostobrachial Nerve Block in the Management of Post-mastectomy Pain

Abstract

Abstract Introduction: Mastectomy can lead to post-mastectomy pain syndrome (PMPS). The present study was planned to investigate the effectiveness of intercostobrachial nerve (ICBN) blockade in the alleviation and improvement of pain intensity and upper arm mobility. Materials and Methods: The present study was an observational descriptive study with a prospective longitudinal design conducted in the Department of Physical Medicine and Rehabilitation of a tertiary care hospital in West Bengal, over a period of 18 months. All consenting patients of breast cancer who had undergone mastectomy and presented with PMPS were included in the study. The calculated sample size was 34. After the ICBN block procedure, the pain and upper arm mobility of the patients were measured using a numerical rating scale (NRS) and QuickDASH (QD) scale at 1, 4, and 12 weeks and compared with baseline scores. Results: The mean age of the participants was 48 ± 9.2 years. Of the women, 23.5% were overweight. The mean body mass index of the study participants was 23 ± 2.6 kg/m2. Most participants in the present study had a per capita monthly income of <INR 11,595. The mean duration of PMPS amongst the participants was found to be 8.6 ± 2.9 months. The mean NRS score at baseline was 7.8 ± 0.9. The mean QD score was observed to be 49.9 ± 12.9 at presentation. After the ICBN block was performed, on subsequent measurements at 1 week, 4 weeks, and 12 weeks, it was observed that there was a significant lowering of both pain (mean ± standard deviation [SD] NRS score 3.1 ± 1.1, 2.3 ± 0.7, and 2 ± 0.7), and improvement of upper limb mobility (mean ± SD QD score 25 ± 12.9, 6.4 ± 4.6, and 6.4 ± 4.6). On comparing the pain scores over time, it was observed that there was a statistically significant lowering of the NRS score from baseline till 12 weeks. The same was observed for QD scores. Conclusions: ICBN blockade is an important modality of pain control and quality of life improvement in patients suffering from PMPS in their post-operative period.