scholarly journals Ultrasound-Guided Superficial Serratus Plane Block for Persistent Post-Mastectomy Pain: Four Case Reports

Author(s):  
Qian Liu ◽  
Khanna Ashish ◽  
Michael Stubblefield ◽  
Guanghui Yue ◽  
Didier Allexandre

Abstract Background: Persistent post-mastectomy pain (PPMP) is common after surgery. Although multiple modalities have been used to treat this type of pain, including physical medicine, physical therapy and interventional approaches, managing PPMP may be still a challenge for breast cancer survivors. Currently, serratus plane block (SPB) as a novel regional anesthetic technique shows promising results for controlling chronic pain. Methods: We report four cases of patients with PPMP that were performed using superficial serratus plane block (SSPB) at our clinic. A retrospective review of effect of pain relief was collected through postprocedure interviews.Results: We found that two of our patients were successfully treated with SSPB for pain after treatment for breast cancer. The third patient had an intercostobrachial nerve block that produced incomplete pain relief, but had adequate pain relief with a SSPB. However, the fourth patient reported no pain relief after SSPB.Conclusion: These cases illustrate that the patients with PPMP could benefit from SSPB. Particularly, we find patients with a subjective sense of “tightness” relating to reconstructive surgeries may be a good candidate for SSPB. Further studies are warranted to evaluate this block for PPMP, as it is low risk and relatively simple to perform.

2021 ◽  
pp. 933-943
Author(s):  
Tal Sella ◽  
Craig Snow ◽  
Hannah Freeman ◽  
Philip D. Poorvu ◽  
Shoshana M. Rosenberg ◽  
...  

PURPOSE Patient-centered digital interventions may help empower young women to self-manage symptoms and psychosocial concerns and support informational needs often unaddressed in clinic. METHODS Young, Empowered and Strong (YES) is an interactive web-based intervention designed to engage young women with personalized education and symptom self-management resources on the basis of responses to patient-reported outcome–based questionnaires. We piloted YES among young women (< 45 years) with newly diagnosed early breast cancer (EBC) or metastatic breast cancer (MBC) and breast cancer survivors (BCSs). Assessments were deployed weekly (EBC and MBC) or every 4 weeks (BCSs) over 12 weeks. At study completion, use, feasibility, and acceptability of YES were evaluated via a survey and semistructured interview. RESULTS Thirty women were enrolled between April and June 2019: 10 EBC, 10 BCSs, and 10 MBC. The mean age at diagnosis and enrollment was 36 (range 25-44) and 39 (range 31-44) years, respectively. Most participants were actively treated (96%, 27 of 28) with endocrine therapy (54%, 15 of 28) or chemotherapy (43%, 12 of 28). Overall, 61% (180 of 296) of assessments were completed (EBC: 70%, BCSs: 63%, and MBC: 52%). Of 37 patient-reported outcome and need domains, the most frequently triggered were sexual health (EBC: 90%, BCSs: 90%, and MBC: 90%), anxiety (EBC: 80%, BCSs: 90%, and MBC: 90%), stress and mindfulness (EBC: 80%, BCSs: 90%, and MBC: 90%), and fatigue (EBC: 90%, BCSs: 80%, and MBC: 90%). On postpilot survey, participants reported that YES helped them to learn (50%, 7 of 14), monitor (43%, 6 of 14), and manage (57%, 8 of 14) their symptoms. CONCLUSION YES is a feasible and acceptable digital intervention to support young women across the breast cancer care continuum. The nearly universal triggering of sexual and mental health needs suggests suboptimal management in the clinical setting and the potential for self-management through a digital platform.


Menopause ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Allison M. Quick ◽  
Filadelfiya Zvinovski ◽  
Catherine Hudson ◽  
Andrew Hundley ◽  
Cynthia Evans ◽  
...  

Author(s):  
Helena Carreira ◽  
Rachael Williams ◽  
Harley Dempsey ◽  
Susannah Stanway ◽  
Liam Smeeth ◽  
...  

Abstract Purpose There is limited high-quality evidence on quality of life, anxiety, and depressive symptoms in breast cancer survivors and women with no history of cancer. We aimed to address this by comparing patient-reported outcomes between breast cancer survivors and women with no history of breast cancer. Methods Breast cancer survivors and women with no prior cancer were selected from the UK Clinical Practice Research Datalink GOLD primary care database, which includes population-based primary care electronic health record data. Breast cancer survivors and controls were frequency matched by age and primary care practice. Outcomes were assessed with validated instruments via postal questionnaire. Linear and logistic regression models were fitted to estimate adjusted associations between breast cancer survivorship and outcomes. Results A total of 356 breast cancer survivors (8.1 years post diagnosis) and 252 women with no prior cancer participated in the study. Compared with non-cancer controls, breast cancer survivors had poorer QoL in the domains of cognitive problems (adjusted β (aβ) = 1.4, p = 0.01), sexual function (aβ = 1.7, p = 0.02) and fatigue (aβ = 1.3, p = 0.01), but no difference in negative feelings, positive feelings, pain, or social avoidance. Breast cancer survivors had higher odds of borderline-probable anxiety (score ≥ 8) (adjusted OR = 1.47, 95%CI:1.15–1.87), but no differences in depression. Advanced stage at diagnosis and chemotherapy treatment were associated with poorer QoL. Conclusions Compared with women with no history of cancer, breast cancer survivors report more problems with cognition, sexual function, fatigue, and anxiety, particularly where their cancer was advanced and/or treated with chemotherapy. Implications for Cancer Survivors Breast cancer survivors with more advanced disease and/or treated with chemotherapy should be closely monitored and, when possible, offered evidence-based intervention for fatigue, cognitive dysfunction, and sexual problems.


2020 ◽  
Vol 106 (6) ◽  
pp. 480-490
Author(s):  
Michele Divella ◽  
Luigi Vetrugno ◽  
Serena Bertozzi ◽  
Luca Seriau ◽  
Carla Cedolini ◽  
...  

Objective: To investigate the prevalence and risk factors associated with chronic pain and other symptoms related to breast cancer 6 months after surgery. Methods: In an observational study of 261 female breast cancer survivors treated between January 2017 and January 2018, patients were asked about their pain symptoms using a questionnaire that utilized the Numeric Rating Score (NRS) and the Douleur Neuropathique Score (DN4) for neuropathic pain; it also addressed phantom sensations and functional disorders on the ipsilateral shoulder. A total of 218 women completed the survey. Results: A total of 105 patients (48.17%) reported chronic pain. Of these, 64% rated the pain with an NRS of 1–3 and 35% with an NRS >3. Neuropathic pain was reported in 65% of the sample, phantom sensations in 12%, disorders of shoulder function in 16%, and web syndrome in 2%. Multivariable analyses showed that chronic pain (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.094–5.942; p < 0.05) and neuropathic pain (OR, 2.988; 95% CI, 1.366–6.537; p < 0.05) were positively associated with surgical adverse events; phantom sensations were statistically associated with the weight of removed breast tissue (OR, 1.003; 95% CI, 1.001–1.005; p < 0.05). Conclusions: Our study highlights the need to employ specific tools capable of detecting different kinds of chronic pain after breast cancer surgery to improve pain prevention and treatment. Surgical complications and the weight of removed breast tissue emerged as 2 of the risk factors for chronic and neuropathic pain development in breast cancer survivors.


2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 200-200
Author(s):  
Wilma Kuijpers ◽  
Wim G Groen ◽  
Hester SA Oldenburg ◽  
Michel W.J.M. Wouters ◽  
Neil K Aaronson ◽  
...  

200 Background: MijnAVL is an interactive portal that includes patient education, an overview of appointments, access to the electronic medical record (EMR), patient-reported outcomes plus feedback and physical activity support. The aim of this feasibility study was to evaluate use, satisfaction and preliminary effects among breast cancer survivors. Methods: We included women currently or recently treated for breast cancer with curative intent. At baseline, they completed a questionnaire on sociodemographics, expectations of MijnAVL and three effect measures: patient activation (PAM), quality of life (SF-36), and physical activity (IPAQ). MijnAVL could be used noncommittally for 4 months. Log data were collected retrospectively and participants completed questions on satisfaction and effect measures. This process was conducted twice, to be able to improve MijnAVL iteratively. Results: We included 92 women (mean age 49.5 years, 59% on-treatment). Mean number of logins was 8.7 and mean duration 13.1 minutes. Overview of appointments (80% of participants) and access to the EMR (90%) were most frequently used and most appreciated. Website user satisfaction was rated 3.8 on a 1-5 scale on average and participants were primarily positive about the accessibility of information. We did not find an effect on the PAM. For the SF-36, we found significant improvements on the role functioning – emotional (65.3 to 78.5, p< .01), mental health (69.8 to 76.5, p< .01) and social functioning (71.2 to 80.5, p< .01) domains. Median vigorous physical activity significantly increased from 0 to 360 MET-minutes per week (p< .05); levels of walking and moderate physical activity did not change significantly over time. These effects were not related to the intensity of use of MijnAVL. Conclusions: This study showed that user experiences were positive and that exposure to MijnAVL resulted in improvements on three quality of life domains and vigorous physical activity. More tailored, interactive features might be needed to substantially change empowerment, quality of life and physical activity. Research with a controlled design and possibly a more sensitive measure for patient empowerment are needed to substantiate our findings.


2020 ◽  
Vol 41 (6) ◽  
pp. 825
Author(s):  
Janmenjoy Mondal ◽  
Abhishek Basu ◽  
Bhukya Swetha ◽  
Shinjini Chakrabarty ◽  
Debjit Ghosh ◽  
...  

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