Ultrasound-guided superficial serratus plane block for persistent post-mastectomy pain: four case reports

Qian Liu,Ashish Khanna,Guang H Yue,Michael D Stubblefield,Didier Allexandre

doi:10.1007/s00520-021-06696-7

Abstract

Persistent post-mastectomy pain (PPMP) is common after surgery. Although multiple modalities have been used to treat this type of pain, including medications, physical therapy, exercise interventions, cognitive-behavioral psychology, psychosocial interventions, and interventional approaches, managing PPMP may be still a challenge for breast cancer survivors. Currently, serratus plane block (SPB) as a novel regional anesthetic technique shows promising results for controlling chronic pain.We report four cases of patients with PPMP that were treated using superficial serratus plane block (SSPB) at our clinic. A retrospective review of effect of pain relief was collected through postprocedure interviews.We found that two of our patients were successfully treated with SSPB for pain after treatment for breast cancer. The third patient had an intercostobrachial nerve block that produced incomplete pain relief but had adequate pain relief with a SSPB. However, the fourth patient reported no pain relief after SSPB.These cases illustrate that the patients with PPMP could benefit from SSPB. Particularly, we find patients with a subjective sense of "tightness" relating to reconstructive surgeries may be a good candidate for SSPB. Further studies are warranted to evaluate this block for PPMP, as it is low risk and relatively simple to perform.

Highlights

Breast cancer is the most common malignancy in women worldwide [1].Thousands of patients undergo surgical procedures in the chest and axilla
These cases illustrate that the patients with Persistent post-mastectomy pain (PPMP) could benefit from serratus plane block (SSPB)
We find patients with a subjective sense of “tightness” relating to reconstructive surgeries may be a good candidate for SSPB

Summary

Results

A 68-year-old woman with history of right-sided breast intraductal carcinoma, status post right mastectomy and prophylactic left mastectomy, presented with severe pain described as “burning” and “tightness” “deep inside” the bilateral chest wall for the past 9 years. The spams quickly degenerated into severe neuropathic pain bilaterally, with a “squeezing” feeling described “as if someone were standing on my chest.” Over the years she had tried physical therapy with myofascial release, gabapentin, and duloxetine with either no relief or limiting side effects. She had no improvement following a number of procedures including intercostal nerve blocks, pulsed radiofrequency ablation, and botulinum toxin injections to the chest wall and intercostals. She agreed to a trial of SSPB to address the tightness feeling, given the increased suspicion that the tightness may be of neuropathic origin. Following the second injection two week later she felt no further relief of any symptoms and elected not to return for the third in the series and was subsequently lost to follow-up

Conclusion

Introduction

Discussion