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Research article

Combined Platelet Rich Plasma Intra-articular Shoulder Injection and Stellate Ganglion block, A new Technique for Management of Chronic Post-mastectomy Shoulder Pain Syndrome: A randomized Controlled Trial.

Authors:

Nevert A. Abdel Ghaffar ,

Mansoura University, 35516, Mansoura, EG
About Nevert A.
Lecturer Anaesthesia, Intensive Care and pain management, Faculty of Medicine
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Mohamed A. Ghanem

Mansoura University, 35516, Mansoura, EG
About Mohamed A.
Assistant Professor of Anaesthesia, Intensive Care and pain management, Faculty of Medicine
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Abstract

Background: Adhesive capsulitis of the shoulder is common after breast cancer treatment. We aimed to compare the effects of using stellate ganglion block (SGB) with bupivacaine and ketamine alone versus its combined use with intra-articular platelet rich plasma (PRP) injection in patients with post-mastectomy shoulder pain.

Methods: A prospective randomized open blinded end-point pilot study was conducted in a university-affiliated oncology center during the period from August 2017 till April 2018.

Sixty four patients with chronic post-mastectomy frozen shoulder were enrolled and allocated into one of two groups. Group A received ultrasound guided SGB with ketamine (0.5mg/kg) plus 5ml bupivacaine 0.5% and group B received ultrasound guided SGB using ketamine and bupivacaine in the same dose as group A plus posterior approach shoulder injection with PRP. Numerical rating scale (NRS) at rest and at shoulder movement, range of motions (ROM) of shoulder and disability of arm, shoulder and hand (DASH) questionnaire were recorded. T-test and ANOVA test (for parametric data) and Mann-Whitny test, Wilcoxon rank test and Kruskal-Wallis test (for non-parametric data) were used for analysis.

Results: Group B showed statistically significant improvement in NRS with shoulder movement and DASH score at one, two and three months after injection in comparison to group A (P≤0.001). Also, ROM improved significantly with PRP shoulder injection after one month from injection.

Conclusion: The combination of intra-articular PRP injection with SGB using ketamine as adjuvant to bupivacaine produces dramatic improvement in post-mastectomy chronic shoulder pain. Their combined use reduces the need for analgesia.

How to Cite: Abdel Ghaffar, N.A. and Ghanem, M.A., 2019. Combined Platelet Rich Plasma Intra-articular Shoulder Injection and Stellate Ganglion block, A new Technique for Management of Chronic Post-mastectomy Shoulder Pain Syndrome: A randomized Controlled Trial.. Sri Lankan Journal of Anaesthesiology, 27(2), pp.133–138. DOI: http://doi.org/10.4038/slja.v27i2.8416
Published on 16 Jul 2019.
Peer Reviewed

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