乳房切除後の慢性疼痛を交感神経的に維持するためのラジオ波胸部交感神経摘出術、速報：6ヶ月間の結果

Radiofrequency thoracic sympathectomy for sympathetically maintained chronic post-mastectomy pain, a preliminary report: six months results.

• Diab Fuad Hetta
• Ashraf Amin Mohamed
• Helal F Hetta
• Essam Ezzat Abd El-Hakeem
• Madona Misheal Boshra
• Mohamed Moamen El-Barody
• Montaser A Fattah Mohammad

抄録

AIM:

乳房切除後疼痛症候群（PMPS）に対する交感神経維持型ラジオ波胸部交感神経摘出術の鎮痛効果の評価。

AIM: Evaluation of the analgesic efficacy of radiofrequency thoracic sympathectomy for sympathetically maintained post-mastectomy pain syndrome (PMPS).

方法:

PMPS患者は、TS群（n=33）に無作為に割り付けられ、ラジオ波胸部交感神経摘出術を受けたか、SHAM群（n=33）に割り付けられた。術後の疼痛治療は両群ともデュロキセチン、プレガバリン、トラマドールであった。アウトカム変数は、VAS疼痛スコアが50％以上減少した患者の割合、VASスコアで測定された疼痛強度、6ヶ月間の追跡期間中に評価されたグローバル知覚効果(GPE)であった。

METHODS: Patients with PMPS, randomized to group TS, (n = 33) received radiofrequency thoracic sympathectomy or group SHAM, (n = 33). Post-operative pain treatment consisted of duloxetine, pregabalin, and tramadol for both groups. The outcome variables were the percentage of patients showed > 50% reduction of their VAS pain score, the pain intensity measured by VAS score, and the global perceived effect (GPE) evaluated during 6 months follow-up period.

結果:

痛みが50％以上軽減した患者の割合は、TS群で有意に高く、（TS VS SHAM）25/30（83.3％）対18/31（58％）、P = 0.032、鎮痛剤を使用せずに痛みが50％以上軽減した患者の割合はTS群で有意に高く、10/25（40％）対0/18（0％）、P = 0.032、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.039、P = 0.0390/18 (0%), P = 0.001, さらに、（トラマドール＋デュロキセチン＋プレガバリン）で治療された患者の50%以上の疼痛軽減率はTS群で有意に低かった, 0/25 (0%) vs. 13/18 (75%), P = 0.001.VAS疼痛スコアは、術後2週間、（1ヶ月、2ヶ月、3ヶ月、6ヶ月）の時点でTS群で有意に低かった。GPEはTS群で有意に高かった[中央値(IQR)]、[7(5:7) vs. 5(4:6)] P < 0.001。

RESULTS: A significant higher percentage of patients gained > 50% reduction of pain in TS group, (TS VS. SHAM) 25/30 (83.3%) vs. 18/31 (58%), P = 0.032, the percentage of patients gained > 50% reduction of their pain without analgesics was significantly higher in group TS, 10/25 (40%) vs. 0/18 (0%), P = 0.001, furthermore, the percentage of patients gained > 50% reduction of their pain treated with (tramadol +duloxetine+pregabalin) was significantly lower in group TS, 0/25 (0%) vs. 13/18 (75%), P = 0.001. VAS pain score was significantly lower in TS group at two weeks, (one, two, three, and six) months following the procedure. The GPE was significantly higher in group TS [median (IQR)], [7 (5:7) vs. 5 (4:6)] P < 0.001.

結論:

交感神経維持型乳房切除後疼痛症候群（PMPS）に対するラジオ波胸部交感神経摘出術は、VAS疼痛スコアを低下させ、抗神経障害薬（特にオピオイド薬）の必要性を減らし、患者の満足度を向上させた。

CONCLUSIONS: Radiofrequency thoracic sympathectomy for sympathetically maintained PMPS decreased VAS pain score, reduced the need to anti-neuropathic drugs, particularly opioid medications and provided a better patient's satisfaction.

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