The effects of intercostobrachial nerve block on acute and chronic postoperative pain after unilateral mastectomy and axillary lymph node dissection surgery

The postmastectomy pain syndrome (PMPS) is a common situation regarded as a chronic neuropathic pain condition after surgery for breast cancer. In this study we have investigated the effects of intercostobrachial nerve blockade during breast surgery on postoperative analgesic consumption and chronic pain insidance. 60 patients underwent modified radical mastectomy with axillary dissection for breast carcinoma were randomly divided into two groups, on the first group intercostobrachial nerve block was performed by the surgeon during surgery with on 10cc % 0,5 bupivacaine injected than nerve was sectioned from the distal part five minutes after injection (Group BT; n=30); intercostobrachial nerve block was not performed on the second group (Group T; n=30). Both groups underwent general anesthesia and postoperative analgesia with tramadol PCA (a bolus dose of 25 mg, a lock-out time of 15 minute and a maximum dose of 300 mg with 4 hours limited were performed) was administered. Pain severity (VAS), analgesic consumption, hemodynamics, and side effects were recorded in the first 48 hours postoperatively. The frequency of neuropathic pain was assessed using the Douleur Neuropathique 4-question survey (DN4) and visual analog scores (VAS) in the first postoperative week, first and third postoperative months. If patients DN4 score is above 4 we have noted positive for neurophathic pain. Intercostobrachial the nerve block group DN4 scores on the 1st postoperative week and 3rd postoperative month and VAS scores on the 1st week, 1st and 3 rd postoperative month after surgery were significantly lower in the Grup BT compared to control group. No significant difference was observed in acute postoperative pain scores, tramadol consumption, hemodynamics and adverse effects such as nausea-vomiting betweeen groups. The intercostobrachial nerve block is a new technique that is not found in the literature, and it is an effective method to reduce the chronic neuropathic pain development after a breast cancer but did not decrease acute postoperative pain.