The aim of this study is to compare the effectiveness of super-voltage pulsed radiofrequency of stellate ganglion and super-voltage pulsed radiofrequency of T2-T3 sympathetic ganglia in the treatment of postmastectomy pain syndrome.
Female patients aged 18-60 years.
Patient of class II according to the American society of Anesthesiologists (ASA) physical status classification system.
History of unilateral mastectomy for breast cancer.
Persistent pain >3 months postoperatively.
Coagulopathy or anticoagulant therapy.
Local infection at injection site.
History of psychiatric illness or cognitive dysfunction.
Previous intervention in the same region (e.g., prior stellate ganglion block or thoracic radiofrequency ablation).
Parallel
Group S : Stellate Ganglion supervoltage pulsed radiofrequency
Procedure/Surgery· Super-voltage pulsed radiofrequency (PRF) of the stellate ganglion was performed under strict aseptic precautions with standard monitoring. Patients were positioned supine with a slight extension of the neck and head turned contralaterally. Ultrasound guidance using a high-frequency linear transducer was employed to identify the stellate ganglion region at the level of the C6 transverse process, anterior to the longus colli muscle and medial to the carotid sheath. A 22-gauge radiofrequency cannula (5-10 cm length, 5-mm active tip) was advanced using an in-plane technique until the needle tip was positioned adjacent to the sympathetic chain on the surface of the longus colli muscle. After negative aspiration, sensory (50 Hz) and motor (2 Hz) stimulation were performed to confirm appropriate needle placement and exclude somatic nerve involvement. Pulsed radiofrequency was then delivered using a supervoltage protocol with a pulse width of 20 ms at a frequency of 2 Hz, applied
Group T : T2-T3 chains supervoltage pulsed radiofrequency.
Procedure/SurgeryPosition the patient prone with bolsters to minimize lordosis and allow C- arm AP and oblique imaging. Under sterile conditions use fluoroscopy to identify T2 and T3 pedicles, ribs and transverse processes. A posterior paravertebral (transforaminal-style) approach is commonly used: advance a curved RFA cannula (20-22G, 10-15 cm with 5-10 mm active tip) under fluoroscopic AP and lateral guidance to the anterolateral aspect of the vertebral body or just anterior to the costotransverse junction at the T2 and T3 levels, the expected location of the thoracic sympathetic chain. Confirm needle position with small (0.5-1 mL) contrast injection to exclude intravascular or pleural spread. Perform sensory (50 Hz) and, if applicable, motor (2 Hz) stimulation to exclude intercostal motor/pleural/nerve root proximity. For supervoltage PRF, deliver radiofrequency with pulse width 20ms at 2 Hz while maintain the electrode tip temperatue less than 42°C for 120-240 seconds at each level
Change in VAS score in groups
Change in visual analogue scale score in groups at different time intervals (baseline, 1 week, 1 month, 3 months, 6 months)
Change in Brief Pain Inventory in groups.
Change in Brief Pain Inventory (BPI) score reflecting functional improvement.
Patient satisfaction
Patient satisfaction using patient global impression of change (PGIC)scale
dose reduction in antineuropathic drugs
dose reduction in antineuropathic drugs
procedural complications.
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