Stellate Ganglion Block: Comparison of Different Doses of Ketorolac After Breast Cancer Surgeries

Abstract

Background: Despite advances in breast conservation therapy, upper limb edema is still a typical concern for those who have undergone treatment for breast cancer. Objective: The purpose of this research was to evaluate the effects of a fixed dose of lidocaine combined with two different doses of ketorolac for stellate ganglion block (SGB) for decreasing pain and size of post mastectomy upper limb lymphedema after breast cancer surgery Patients and methods: Forty patients that underwent mastectomy were randomly assigned to one of two research groups in this prospective randomized study (20 patients in each group) received either ultrasound guided SGB with solution of 4 ml lidocaine 2% & 15 mg ketorolac in total volume 10 ml (group 1) or ultrasound guided SGB with solution of 4 ml lidocaine 2% & 30 mg ketorolac in total volume 10 ml (group 2). Assessment was done after SGB for 3 weeks by collecting data of total analgesic consumption as primary outcome, first analgesic request, VAS score and arm circumference. Results: Total analgesic dose /tablet was significantly decreased 19 (4-30) in group 2 versus 34 (20-63) in group 1, first analgesic request /hours 8 (5-54) in group 2 versus 4 (2-8) in group 1. At 2 and 3 weeks post-block, there was a significant reduction in group members' arm circumference both 5 and 10 centimeters above and below the elbow crease. Conclusion: Higher dose of ketorolac could be associated with better analgesia, lower VAS score and with more upper limb lymphedema size reduction post-mastectomy.