DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20170141

Preserving of intercostobrachial nerve relieves breast carcinoma patients from postmastectomy pain syndrome

Girish N. M. Kumar, Ramesan Chayampurath, Sasi M. Parambil

Abstract


Background: Post-mastectomy pain syndrome (PMPS) is a complication experienced by majority of the patients who undergo breast surgery for cancer. The etiology of this chronic neuropathic pain syndrome seems to be complex and it is still understood below par. Injury to the intercostobrachial (ICB) nerve is presumed to be the dominant one for developing PMPS. This prospective study was designed to appraise the effect of preservation of intercostobrachial nerve on post-mastectomy pain syndrome and also to determine the most common anatomical variation of the intercostobrachial nerve during surgery.

Methods: A total of 100 patients were included in this study and were divided into 2 groups. Group A included patients with ICB nerve preserved and Group B patients with ICB nerve sectioned. The patients were evaluated for pain subjectively on the 2nd day, 1 month and in the 3rd month post-operatively by short form of McGill pain questionnaire and visual analog scale. During surgical dissection, anatomical variation of ICB nerve was ascertained each time.

Results: After 3 months, 68.2% of the patients were asymptomatic in Group A (ICB nerve preservation group) and 31.8% in the Group B (nerve section group) (chi-square test was applied and p value was 0.002). We found that type 1 anatomical variation was commonest with 87%.

Conclusions: Preservation of ICB nerve might greatly decrease the incidence of PMPS. Hence, the insight of the anatomical variations of this nerve is very crucial for the operating surgeons to preserve them and to prevent PMPS.


Keywords


Intercostobrachial nerve, Post mastectomy pain syndrome

Full Text:

PDF

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 Clin Epidemiol. 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. An unusualunion of the intercostobrachial nerve and the medial pectoral nerve. Folia Morphol (Warsz). 2007;66(4):356-9.

Cunnick GH, Upponi S, Wishart GC. Anatomical variants of the intercostobrachial 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 Surg Oncol. 2003;29(3):213-5.

Dini D, Bertelli G, Gozza A, Forno GG. Treatment of the postmastectomy pain syndrome with capsaicin. Pain. 1993;54:223-6.

Melzack R. The Short-Form Mcgill Pain Questionnaire. Pain. 1987;30(2):191-7.

Dudgeon D, Raubertas RF, Rosenthal SN. The Short Form Of Mcgill pain Questionnaire In Chronic Cancer Pain. J Pain Symptom Manage. 1993;8(4):191-5.

Burchardt CS, Bjelle A. A Swedish Version Of The Short-Form Of Mcgill Pain Questionnaire. Scand. J Rheumatol. 1994;23(2):77-81.

Teicher I, Polard B, Wise L. Preservation of the intercostobrachial nerve during axillary dissection for carcinoma of the breast. SurgGynaecolObstet. 1982;155:891-2.

Temple WJ, Ketcham AS. Preservation of the intercostobrachial nerve during axillary dissection for breast cancer. Am J Surg. 1985;150:585-8.

Abdullah TI, Iddo J, Barr L, Baildam AD, Burndred NJ. Prospective randomized controlled trial of preservation of the intercostobrachial nerve during axillary node clearance for breast cancer. Br J Surg. 1998;85:1443-5.

Bratschi HU, Haller U. Significance of the interocostobrachial nerve in axillary lymph node excision. Geburtshilfe Frauenheilkd. 1990;50:689-93.

Torresan RZ, Cabello C, Conde DM, Brenelli HB. Impact of the preservation of the intercostobrachial nerve in axillary lymphadenectomy due to breast cancer. The Breast. 2003;9(5):389-92.

Miguel R, Kuhn AM, Shons AR. The effect of sentinel node selective axillary lymphadenopathy on theincidence of post-mastectomy pain syndrome. Cancer Control. 2001;8(5):427-30.

Salmon RJ, Ansquer Y, Asselain B. Preservation versus section of intercostobrachial nerve (IBN) in axillary dissection for breast cancer - a prospective randomized trial. Eur J SurgOncol. 1998;24:158-61.

Katz J, Poleshuck EL, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for acute pain and its persistence following breast cancer surgery. Pain. 2005;119:16-25.

Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Klick DL, et al. Risk factors in chronic pain after breast cancer surgery: a prospective study. J Pain. 2006;7(9):626-34.