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

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.