Thesis (Ph.D.) - Cairo University - National Cancer Institute - Department of Anaesthesia and Pain Relief

Background: Breast cancer is one of the most common neoplastic tumors in women, and surgical treatment is indicated in most patients. Persistent pain related to this treatment, such as post-mastectomy pain syndrome (PMPS), has been reported in many cases. Although the development of the pain is multifactorial, injury of the intercostobrachial nerve is the major cause of this type of pain. Pulsed radiofrequency (PRF) is an alternative therapeutic technique that has recently been developed and used by pain practitioners as a non neurodestructive technique for relief of chronic peripheral Neuropathic Pain (NP), when it applied on dorsal root ganglions (DRGs). Many mechanisms can explain the anti-inflammatory effect of transforaminal epidural steroid injection, and its analgesic effect on peripheral NP such as inhibition of phospholipase, alterations in lymphocytes, and inhibition of cytokine expression and stabilization of the cellular membrane. Objective: Evaluation of efficacy and safety of PRF and steroid injection on T2 and T3 DRGs for intercostobrachial neuralgia (ICBN) post mastectomy. Study design: Prospective case series study. Methods: One hundred patients with ICBN were selected from the pain clinic of the national cancer institute, Cairo university according to Inclusion criteria and exclusion criteria after institutional review board approval. The study extended from May 2015 to December 2016. The RF needles were introduced on the DRG at T2, T3 levels using a tunnel vision technique from the oblique view under C-arm fluoroscopic machine guidance after alignment of the lower end plates of the targeted vertebrae

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