Ultrasound guided BRILMA block for the management of post-mastectomy pain syndrome in oncological parients: a series of cases

Abstract

Introducción: Post-mastectomy pain syndrome is defined as persistent pain that appears shortly after mastectomy/lumpectomy, and the prevalence is about 20-60 % of patients undergoing mastectomy, as for the characteristics of pain is described as neuropathic. On the other hand the modified block of the lateral intercostal branches at the middle axillary level, it is postulated as an alternative for the analgesic management of this pain syndrome which is considered a minimally invasive technique and low difficulty of execution. Objective: Determine decrease of pain in patients with post-mastectomy pain syndrome after ultrasound-guided BRILMA block. Methods: Prior to acceptance of the procedure, placement patient, and sterile technique; the ultrasound-guided BRILMA Block was performed, once the anatomical structures were identified according to the technique described, the needle was placed in the interfacial plane and to manage a volume of 15 cc which is composed of (5 cc ropivacaine 0.187 % + 2 cc dexamethasone depot 4 mg + 8 cc of water for injection) was administered. Results: A total of 6 women with post-mastectomy pain syndrome were included for the Brilma block during July to December 2022, of the Oncology Unit. A decrease in pain was found to be greater than 50% over the basal intensity. The duration of pain decrease above 50% after the procedure was 4 to 8 months. The drug doses and therefore undesirable effects were decreased. Conclusion: Despite the limitation that exist in the literature for not having reports of large studies that implement the technique carried out in this study, for the management of postmastectomy pain syndrome, it is described that interfacial approach are a feasible option. Interventional procedures have a multiple benefits, so it´s important to continue with the lines or research in order to find better alternatives in the treatment of pain.