Choi, E., Nahm, F.S., & Lee, P.B. (2015). Sympathetic block as a new treatment for lymphedema. Pain Physician, 18, 365–372.

To study the effects of thoracic a sympathetic ganglion block (TSGB) in treating breast cancer-related lymphedema

The medical records of patients who received a TSGB were reviewed. Findings were compared between patients who were grouped according to therapeutic efficacy. TSGBs were performed under fluoroscopic guidance. An injection of contrast agent was used to confirm the proper positioning for the injection of lidocaine. Patients had arm circumference measurements and completed the Lymphedema and Breast Cancer Questionnaire two weeks and two months after the TSGB procedure. Arm circumference was measured at the axilla, upper arm, elbow, lower arm, and wrist.

• N = 35  
• MEAN AGE = 55.8 years (SD =1.99 years, range = 38–80 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: All participants received a mastectomy for breast cancer and either axillary lymph node dissection with sentinel a lymph node biopsy or a sentinel lymph node biopsy alone. All participants had unilateral lymphedema.
• OTHER KEY SAMPLE CHARACTERISTICS: The mean onset of lymphedema after surgery was 10.97 months. The mean time from lymphedema onset till the procedure was 23.47 months.

• SITE: Single site  
• SETTING TYPE: Not specified    
• LOCATION: South Korea

• PHASE OF CARE: Late effects and survivorship

Retrospective, descriptive study

• Arm circumference
• Effective TSGB was defined as at least a 50% reduction in arm circumference difference between the affected and unaffected arm.
• Lymphedema was staged from 0–3 according to the observation of physical signs.
• Lymphedema and Breast Cancer Questionnaire (LBCQ)

The most frequent lymphedema severity was stage 2, which involved visible edema, usually with pitting and hardened, thickened skin and tissue (37.5% of cases). Arm circumference measures at all locations decreased significantly at two weeks after the procedure (p < 0.05). There was no significant additional decrease between two weeks and two months after the procedure. Questionnaire results also showed a significant reduction in symptoms at two weeks (p < 0.001) with no additional improvement between two weeks and two months. Overall, 65.7% of participants were deemed to have effective TSGB results. Those with more severe lymphedema tended to have the most improvement.

TSGBs may be a useful option for the management of breast cancer-related arm lymphedema. The mechanism by which this may be effective is unclear, and the duration of any improvement is not yet clear.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement/methods not well described
• Measurement validity/reliability questionable

TSGBs may be an alternative option for patients with breast cancer-related arm lymphedema for whom conservative and standard treatments were unsuccessful. Additional research providing sufficient evidence for the effectiveness and identification of patients for whom the intervention is appropriate is needed.