Abstract
Although the sympathetic nerve system has been described as a modulator of lymphatic circulation, it has not been targeted in the treatment of lymphedema. We conducted a systematic review of publications assessing the use of sympathetic nerve block in lymphedema treatment. We hypothesized that sympathetic nerve block may be a promising treatment option for lymphedema patients. We conducted a comprehensive systematic review of the published literature on the use of sympathetic nerve block in lymphedema treatment using the PubMed database. Eligibility criteria excluded papers that reported other types of lymphedema treatment or any other anesthesiology procedure. s, presentations, reviews, and meta-analyses were also excluded. Extracted data included the year of study, country, author affiliation, type of study, patient characteristics, nerve block technique, and key findings. From 81 potential papers, eight studies fulfilled the eligibility criteria. All papers identified were clinical, reporting on a total of 187 patients. Sympathetic nerve block was proposed with local anesthetics, whether or not associated with triamcinolone. Treatment with a nerve block promoted lymphedema improvement expressed by decreased limb circumference and patient-reported outcomes. Large randomized clinical trials are still pending, but sympathetic nerve block seems to be a promising alternative for lymphedema patients who do not respond to conservative therapy.
Highlights
BackgroundLymphedema is a chronic condition that affects five to six million people in the United States alone
Sympathetic nerve block was proposed with local anesthetics, whether or not associated with triamcinolone
Large randomized clinical trials are still pending, but sympathetic nerve block seems to be a promising alternative for lymphedema patients who do not respond to conservative therapy
Summary
BackgroundLymphedema is a chronic condition that affects five to six million people in the United States alone. Lymphedema is mostly related to cancer treatment, having incidences as high as one in every six patients undergoing surgical treatment of a solid tumor [1]. Considering that lymphedema is still an incurable disease, studies on targeted therapies have attracted the attention of the scientific community. It is well-accepted that the physiopathology behind lymphedema is associated with inflammation and fibrosis, where normal tissue is replaced by scar tissue [2,3,4]. The translation of some of these therapies into clinical practice raises concern for metastasis in patients with a medical history of cancer [6]
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