Effects of stellate ganglion block on breast cancer-related lymphedema: Comparison of various injectates

Abstract

Background: Stellate ganglion block (SGB) has been reported to be effective in the treatment of breast cancer-related lymphedema (BCRL). Objective: To determine the effects of SGB in BCRL patients and the efficacy of corticosteroids in SGB. Study Design: A double-blinded, randomized, controlled trial. Setting: A single academic hospital, outpatient setting. Methods: In total, 32 patients with BCRL were recruited. Patients were divided randomly into 3 groups (Group A: 0.5% bupivacaine 5 mL, n = 12; Group B: 0.5% bupivacaine 4.5 mL + 20 mg of triamcinolone 0.5 mL, n = 10; and Group C: 0.5% bupivacaine 4 mL + 40 mg of triamcinolone 1 mL, n = 10). All patients received 3 consecutive SGBs, every 2 weeks. The primary outcomes were changes in forearm and upper arm circumference. Circumference was measured at baseline, 2 weeks (before the second injection), 4 weeks (before the third injection), and 8 weeks (one month follow-up after 3 consecutive SGBs). Moreover, subjective data were collected using EORTC C-30 at baseline and 8 weeks. Results: After 3 consecutive SGBs, forearm and upper arm circumferences were decreased significantly from baseline in all groups (P < 0.05/3). The upper arm circumference of group C was reduced significantly more than that of group A (P < 0.05/3). The subjective data by EORTC-C30 at baseline and one month after 3 consecutive SGBs revealed no statistically significant difference. Limitations: Relatively few patients were enrolled. We did not compare SGB with any other BCRL treatment, such as complex decongestive therapy. Conclusions: This study suggests that SGB may be an effective treatment for BCRL. Furthermore, it appears that corticosteroids could have an additive effect in SGB.