Wijayasinghe, N., Andersen, K.G., & Kehlet, H. (2014). Neural blockade for persistent pain after breast cancer surgery. Regional Anesthesia and Pain Medicine, 39, 272–278. 

DOI Link

Purpose

STUDY PURPOSE: To review the literature and determine the effects of neural blockades for persistent pain after breast cancer surgery (PPBCS)
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE, PubMed, Scopus, and EMBASE
 
KEYWORDS: [breast neoplasms/surgery AND neural blockade] [breast neoplasms/surgery AND intercostobrachial] [breast cancer (MAJR topic) AND surgery (MAJR topic) AND pain (MAJR topic)] [breast cancer pain AND intercostobrachial nerve] and the following keywords in all three databases: [intercostobrachial], [(intercostobrachial AND breast cancer)], [(intercostobrachial) AND (breast cancer pain)], [(intercostobrachial) AND (blockade) AND (breast)], [(medial cutaneous nerve) AND (breast pain)], [(pectoral nerves)AND(breast pain)], [(long thoracic nerve) AND (breast pain)], [(thoracodorsal nerve) AND (breast pain)], [(intercostal nerves) AND (breast pain)] [(medial cutaneous nerve block) AND (breast cancer )], [(pectoral nerve block) AND (breast cancer)], [(long thoracic nerve block) AND (breast cancer)], [(thoracodorsal nerve block) AND (breast cancer)], [(intercostal nerve block) AND (breast cancer)]
 
INCLUSION CRITERIA: Studies written in English concerning patients who had undergone breast cancer surgery; patients developed persistent pain; and patients received a local anesthetic block in the course of treatment for their pain
 
EXCLUSION CRITERIA: Studies on phantom breast pain; the use of neural blockades in the perioperative period; and treatments for PPBCS that did not target nerves

Literature Evaluated

TOTAL REFERENCES RETRIEVED: Eight were eligible
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Grades of recommendation, assessment, development, and evaluation

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 7
  • TOTAL PATIENTS INCLUDED IN REVIEW = 135
  • SAMPLE RANGE ACROSS STUDIES: Not provided
  • KEY SAMPLE CHARACTERISTICS: Postmastectomy

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Palliative care

Results

1) All of the four intercostal nerve block studies were performed in the case series (n = 15), and eight (53%) of 15 patients experienced complete pain relief from the local anesthetic blockade.
2) The two SGB studies showed statistically significant reductions in pain scores for as many as three months after the blocks, but eight (11%) of the 75 patients did not respond to the block.
3) In the PVB study, two (20%) of 10 patients were pain-free after five months.

Conclusions

This review demonstrated a lack of high-quality research on neural blockades for PPBCS, which is predominantly a neuropathic pain syndrome.

Limitations

  • This review found that the studies included for the analysis were of low quality because of the case studies included (n = 4; 56%).
  • Only two randomized, controlled trials were included.

Nursing Implications

Because of the low quality of the included studies and the small number of randomized, controlled studies of studies in this review, little evidence for neural blockades for PPBCS can be used for nursing at this time point.

Legacy ID

5194