Abstract
Background: Adhesive capsulitis of the shoulder is common after breast cancer treatment. We aimed to compare the effects of using stellate ganglion block (SGB) with bupivacaine and ketamine alone versus its combined use with intra-articular platelet rich plasma (PRP) injection in patients with post-mastectomy shoulder pain. Methods: A prospective randomized open blinded end-point pilot study was conducted in a university-affiliated oncology center during the period from August 2017 till April 2018. Sixty four patients with chronic post-mastectomy frozen shoulder were enrolled and allocated into one of two groups. Group A received ultrasound guided SGB with ketamine (0.5mg/kg) plus 5ml bupivacaine 0.5% and group B received ultrasound guided SGB using ketamine and bupivacaine in the same dose as group A plus posterior approach shoulder injection with PRP. Numerical rating scale (NRS) at rest and at shoulder movement, range of motions (ROM) of shoulder and disability of arm, shoulder and hand (DASH) questionnaire were recorded. T-test and ANOVA test (for parametric data) and Mann-Whitny test, Wilcoxon rank test and Kruskal-Wallis test (for non-parametric data) were used for analysis. Results: Group B showed statistically significant improvement in NRS with shoulder movement and DASH score at one, two and three months after injection in comparison to group A (P≤0.001). Also, ROM improved significantly with PRP shoulder injection after one month from injection. Conclusion: The combination of intra-articular PRP injection with SGB using ketamine as adjuvant to bupivacaine produces dramatic improvement in post-mastectomy chronic shoulder pain. Their combined use reduces the need for analgesia.
Highlights
Adhesive capsulitis of the shoulder is a debilitating state characterized by progressive pain and a reduced range of movements about the glenohumeral joint that occurs frequently after breast cancer surgery.[1]Frozen shoulder progresses in three stages: the freezing (2-9 months), adhesive (4-12 months) and thawing stages (5-26 months).[2]
The combination of intra-articular platelet rich plasma (PRP) injection with stellate ganglion block (SGB) using ketamine as adjuvant to bupivacaine produces dramatic improvement in post-mastectomy chronic shoulder pain. Their combined use reduces the need for analgesia
Positive effects of PRP were reported in treatment of osteoarthritis of the knee; tendinopathies and rotator cuff injuries[6] with limited trials for post-mastectomy chronic shoulder pain management
Summary
Adhesive capsulitis of the shoulder (frozen shoulder) is a debilitating state characterized by progressive pain and a reduced range of movements about the glenohumeral joint that occurs frequently after breast cancer surgery.[1]Frozen shoulder progresses in three stages: the freezing (2-9 months), adhesive (4-12 months) and thawing stages (5-26 months).[2]. Adhesive capsulitis of the shoulder (frozen shoulder) is a debilitating state characterized by progressive pain and a reduced range of movements about the glenohumeral joint that occurs frequently after breast cancer surgery.[1]. There is a controversy about the ideal therapeutic approach These approaches include intra-articular injections, hydrosilation, manipulation under anaesthesia and surgical capsular release.[1] Among these techniques, stellate ganglion block (SGB) was emerging as an effective technique with an early onset of action.[3] there is no agreement about its use in complex regional pain syndrome. We aimed to compare the effects of using stellate ganglion block (SGB) with bupivacaine and ketamine alone versus its combined use with intra-articular platelet rich plasma (PRP) injection in patients with post-mastectomy shoulder pain
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