1. 2015;18;93-99Effects of Stellate Ganglion Block on Breast Cancer-Related Lymphedema: Comparison of Various Injectates
   Randomized Trial
   Seong Min Chun, MD, Kwan Sik Seo, MD, PhD, Yu-Sun Min, MD, and Jae Hyeon Park, MD.

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.