1. 2026;29;E1-E10Early Evaluation of Thermal Radiofrequency vs. Chemical Neurolysis for T2 and T3 Sympathectomy in Post-Mastectomy Pain Syndrome Using Oximetry-Based Perfusion Index Assessment
   Randomized Controlled Trial
   Walaa Y. Elsabeeny, MD, Mahmoud S. Soliman, MD, Taher S. Thabet, MD, and Sayed M. Abed, MD.

BACKGROUND: Post-mastectomy pain syndrome (PMPS) is a chronic neuropathic condition thought to be mediated mainly by the sympathetic nervous system. Effective treatment options for PMPS include T2 and T3 sympathectomy, performed through either thermal radiofrequency (TRF) or chemical neurolysis. 

OBJECTIVES: This trial compares the efficacy of pulsed radiofrequency (RF) to that of neurolysis for post-mastectomy pain relief. 

SETTING: This double-blinded, randomized trial was conducted in the National Cancer Institute of Cairo, Egypt. 

METHODS: Fifty-four female patients with PMPS that did not respond to stellate ganglion blocks were included in the trial. Patients were assigned to receive either TRF (80° C for 120 seconds) or chemical neurolysis (phenol 8%) under fluoroscopic guidance. Primary outcomes included reduced scores on the Visual Analog Scale (VAS). Secondary outcomes included PI changes, skin temperature, opioid and pregabalin consumption, incidence of breakthrough pain, complications, and quality-of-life scores on the 36-Item Short-Form Survey (SF-36). 

RESULTS: Both TRF and chemical neurolysis resulted in significant pain reduction, with improvements >= 50% in VAS scores (77.8% [TRF] vs. 85.2% [neurolysis], P = 0.484). Perfusion index (PI) scores increased more rapidly in the neurolysis group at 5 minutes (5.9 ± 0.9 vs. 5.3 ± 0.7, P = 0.008) but were comparable at 20 minutes. Opioid consumption and breakthrough pain episodes significantly decreased in both groups after the procedures. The TRF group had fewer complications but required a longer procedural duration (22 ± 2 min vs. 16 ± 2 min, P < 0.001). 

LIMITATIONS: This trial took place as a single center study and used a limited sample size. 

CONCLUSION: Both TRF and chemical neurolysis are effective for T2 and T3 sympathectomy in the management of PMPS. Although neurolysis provides faster PI changes, TRF can offer a potentially safer profile. PI can serve as a reliable tool for the assessment of T2 and T3 sympathetic blocks.

KEY WORDS: Post-mastectomy pain syndrome, sympathectomy, thermal radiofrequency, chemical neurolysis, perfusion index