Stellate Ganglionic Block Versus Stellate Ganglionic Block Plus Pecs II Block for Mastectomy Pain

Study Overview
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Brief Summary
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Post mastectomy pain syndrome result from surgical damage to the intercostobrachial nerve, the lateral cutaneous branch of the second intercostal nerve that is often resected at mastectomy. result from surgical damage to the intercostobrachial nerve, the lateral cutaneous branch of the second intercostal nerve that is often resected at mastectomy, A second version of the pectoral nerve block is described, called ''modified Pecs block'' or Pecs block type II. This novel approach aims to block at least the pectoral nerves, the intercostobrachial, intercostals III-IV-V-VI and the long thoracic nerve. These nerves need to be blocked to provide complete analgesia during breast surgery

Detailed Description
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The aim of this study is to evaluate the efficacy of ultrasound guided stellate ganglionic block alone versus stellate ganglionic block plus pecs II block in management of chronic postmastectomy pain ,patient will be trained to use visaual analog scale to describe their pain range of movement will be assessed using manual geniometry at post procedure visits at one month ,3 months and 6 months procedures in each group will done using ultrasound guidance mixture will be used. All patients will be informed about the procedure and its possible consequences after detailed explanation of protocol of this study. Written informed consents will be obtained before the procedure. With each block, an intravenous cannula will be inserted and secured. All suitable resuscitation equipment and drugs will be available. Vital signs (heart rate, blood pressure, and oxygen saturation) will be monitored throughout the procedure and up to 1 hour after the block performance. Midazolam 0.02 ug/kg will be administered intravenously as premedication. Brief evaluation will be done for all patients with regard to their systemic diseases, general condition, and coagulation status. All patients will be familiar with the use of 10-cm visual analogue scale score (VAS) identifying 0 as no pain and 10 as worst imaginable pain.Basal assessment of range of movement for abduction ,external rotation ,and forward flextion using manual geniometry and patients will be asked to complete Quality of life questionnaire

Official Title
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Stellate Ganglionic Block Versus Combined Stellate Ganglionic Block and Modified Pectoral Nerve Block in Treatment of Post Mastectomy Pain Syndrome.

Conditions
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Post Mastectomy Pain Syndrome, After Breast Surgery

Intervention / Treatment
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* Other: Stellate ganglionic block
* Other: Pecs II block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists physical status III or IV. Patients having irradiating pain of anterior chest wall and axilla after breast surgery. Patients having irradiating pain of ipsilateral arm after breast surgery Pain not responding to conservative treatment Pain persisting for more than 3 month Exclusion Criteria: Local skin infection Coagulation or blood disease Pregnancy Postpartum or lactating females Allergy to the study medications. Severely altered consciousness level. Psychiatric disorder Drug abuse Spine or chest wall deformities

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Stellate ganglionic block<br>Ultrasound guided stellate ganglionic block | Other: Stellate ganglionic block<br>* Ultrasound guided stellate ganglionic block<br>|
| Active Comparator: Pecs II block<br>Ultrasound guided Pecs II block | Other: Pecs II block<br>* Ultrasound guided Pecs II block<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain scores | 100 mm- visual analog pain scale | for six months after the procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The range of motion of the glenohumeral joint | Improvements in the range of motion of the glenohumeral joint, which included forward extension and external rotation will be recorded using scoring system score 0 to 9 for some movements range and 0 to 160 for others | for six months after the procedure | 
| The quality of life score | The quality of life will be assessed using the score QOLSF 36 | for six months after the procedure |