Abstract
Background: Postmastectomy pain and sensory disturbances is a complication experienced through majority of the sufferers who undergo breast surgical operation forbreast cancers. The etiology of this neuropathic pain appears to be complex and it is s still understood underneath par. Injury to the Intercostobrachial (ICB) nerve is presumed to be the dominant one. This prospective observe was designed to appraise the effect of protection of Intercostobrachial nerve on post mastectomy pain and sensory disturbances.
Methods: This cross sectional comparative study was done in Rajah Muthiah Medical College and Hospital, Chidambaram between July 2015 to July 2017. In-patients who underwent Modified Radical Mastectomy had been included in the study. The sufferers were divided into two groups. Group A -d patients with ICB nerve preserved and Group B - with ICB nerve sectioned. The patients Evaluated for the post operative and psychosocial morbidities immediate post operative and six months after the MRM via the use of numerous questionnaire and scales.
Results: Fifty patients who underwent MRM were observed out of which nineteen sufferers ICBN were preserved, General Quality of life as Measured by WHOQOL scaleand the observation for ICBN preserved patients is 107% and for ICBN sectioned 90.
Conclusions: Preservation of ICB nerve may significantly lower the occurrence of PMPS and sensory disturbances. Quality of life of patients with Breast Cancer who underwent MRM with intact ICB nerve is much better than those with ICB sectioned.
Keywords: Intercostobrachial nerve, Modified Radical Mastectomy, Post mastectomy pain syndrome. Quality of lifestyles.
References
- Ramesh, Sukla NK, Bhatnagar S. Phantom Breast Syndrome. Indian J Palliative Care. 2009;15(2):103- 7.
- Agarwal G, Pradeep PV, Aggarwal V, Yip CH, Cheung PS. Spectrum of breast cancer in Asian women. World J Surg. 2007;31:1031-40.
- Wallace MS, WallesAM, Lee J, Dobke MK. Pain After Breast Surgery. A Survey of 282 Women. Pain 1996;66(2-3)195-205.
- Tasmuth T, Von Smitten K, Hietanen P, Kataja M, Kalso E. Pain and other symptoms after different treatment modalities of breast. Cancer Ann Oncol. 1995;6(5):453-9.
- Carpenter JS, Andrykowski MA, Sloan P, Cunningham L, Cardova MJ, Studts JL, et al. Post Mastectomy/Post Lumpectomy Pain In Breast Cancer Surviours. J ClinEpidemiol. 1998; 51(12): 1285-92.
- Tasmuth T, Estlanderb A, Kalso E. Effect of present pain and mood on the memory of past postoperative
pain in women treated surgically for breast cancer. Pain. 1996;68:343.
- Fassoulaki A, Sarantopoulos C, Melemeni A. EMLA reduces acute and chronic pain after breast surgery for cancer. Regional Anesthesia& Pain Medicine. 2000;25:350-5.
- Smith WC, Bourne D, Squair J, Phillips DO, Chambers WA. A retrospective cohort study of post mastectomy pain syndrome. Pain. 1999;83:91-5.
- Carpenter JS, Sloan P, Andrykowski MA, McGrath P, Sloan D, Rexford T, et al. Risk factors for pain after mastectomy/ lumpectomy. Cancer Pract. 1999;7:66-70.
- Málek J, Kurzová A, Ambrus M, Vedral T, Lysý M, Príkazský V. Chronic post–mastectomy pain. CasLekCesk. 2006;145:209-12.
- Watson C, Evans R. The post-mastectomy pain syndrome and topical capsaicin: a randomized trial. Pain. 1992;51:375-9.
- Kwekkeboom K. Postmastectomy pain syndromes. Cancer Nurs. 1996; 19:37-43.
- Loukas M, Grabska J, Tubbs RS, Louis RG. Anunusualunion of the intercostob-rachial nerve and the medial pectoral nerve. Folia Morphol (Warsz).2007; 66(4):356-9.
- Cunnick GH, Upponi S, Wishart GC. Anatomical variants of the intercostob-rachial nerve encountered during axillary dissection. The Breast. 2001;10:160- 2.
- Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain. 2003;104:1-13.
- Granek I, Ashikari R, Foley K. The post- mastectomy pain syndrome: clinical and anatomical correlates. Proceedings of the American Society of Clinical Oncology. 1984;3:122.
- Ahmed M, Cook LJ, Douek M. Preservation of the intercostobrachial nerve during axillary node clearance for breast cancer (Protocol). Cochrane Database of Systematic Reviews 2014; 9. Art. No.: CD011229. DOI: 10.1002/ 14651858. CD011229.
- Freeman SR, Washington SJ, Pritchard T, Barr L, Baildam AD, Bundred NJ. Long term results of a randomized prospective study of preservation of the intercostobrachial nerve. Eur J SurgOncol. 2003; 29(3):213-5.
- Dini D, Bertelli G, Gozza A, Forno GG. Treatment of the post mastectomy pain syndrome with capsaicin. Pain. 1993; 54:223-6.
Corresponding Author
Dr Renjithsingh.R
Department of Surgery,
Rajah Muthiah Medical College and Hospital, Chidambaram
DOI: https://dx.doi.org/10.18535/jmscr/v5i11.94
