Sympathetic Nerve Block in Lymphedema Treatment: A Systematic Review

Abstract

Although the sympathetic nerve system has been described as a modulator of lymphatic circulation, it has not been targeted in the treatment of lymphedema. We conducted a systematic review of publications assessing the use of sympathetic nerve block in lymphedema treatment. We hypothesized that sympathetic nerve block may be a promising treatment option for lymphedema patients. We conducted a comprehensive systematic review of the published literature on the use of sympathetic nerve block in lymphedema treatment using the PubMed database. Eligibility criteria excluded papers that reported other types of lymphedema treatment or any other anesthesiology procedure. Abstracts, presentations, reviews, and metaanalyses were also excluded. Extracted data included the year of study, country, author affiliation, type of study, patient characteristics, nerve block technique, and key findings. From 81 potential papers, eight studies fulfilled the eligibility criteria. All papers identified were clinical, reporting on a total of 187 patients. Sympathetic nerve block was proposed with local anesthetics, whether or not associated with triamcinolone. Treatment with a nerve block promoted lymphedema improvement expressed by decreased limb circumference and patientreported outcomes. Large randomized clinical trials are still pending, but sympathetic nerve block seems to be a promising alternative for lymphedema patients who do not respond to conservative therapy.

Radiofrequency Thoracic Sympathectomy for Sympathetically Maintained Chronic Post‐Mastectomy Pain, a Preliminary Report: 6‐Month Results

“…Regarding the effect of thoracic sympathectomy on BCRL of the upper arm, more patients improved in Group TS compared to Group Sham—8 of 11 patients showed decreased lymphedema in Group TS compared with 2 of 10 cases in Group Sham. Studies on BCRL revealed improved outcome; however, these studies recruited small samples and were not controlled 40,41 . Park et al 42 compared the effects of a stellate ganglion block with complex decongestive therapy in 38 patients with BCRL, and they pointed out that both sympathetic block and complex decongestive therapy decreased limb circumference without a statistically significant difference between the 2 groups.…”

Stellate ganglion block beyond chronic pain: A literature review on its application in painful and non-painful conditions

“…[ 51 ] A systematic review that included case reports, retrospective studies, and RCTs, assessed the effect of sympathetic nerve blocks in lymphedema in a sum of 187 subjects and noted that sympathetic blocks reduced lymphedema—shown by reduced limb circumference—and also improved patient-reported outcomes like pain. [ 52 ] A randomized trial compared SGB and CDT in 38 patients with BCRL and found both treatment modalities to be effective in reducing the swelling, and there were no significant differences among the groups. Hence, SGB can be considered as an alternative treatment modality for BCRL.…”

Impact of body mass index on long-term surgical outcomes of vascularized lymph node transfer in lymphedema patients

“…The first-line treatment for lymphedema patients is conservative therapy, but surgical therapies are considered if outcomes are not optimal. Our team have been studying the efficacy of multiple surgical procedures that may be used for treatment of lymphedema (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Between them, vascularized lymph node transfer (VLNT) is a physiologic surgical therapy that consists of removing lymph node tissues from a donor site and transferring these free flaps to the lymphedematous limb (4,17).…”