Predicting the Effect of Stellate Ganglion Block on the Lymphoscintigraphic Findings for Lymphedema in Post-Mastectomy Patients.

, Kim, Hye Ri; , Kim, Keewon; , Kim, Ho Geun; , Lim, Chai Young; , Chun, Se Woong; , Seo, Kwan Sik

Original Article

Journal of the Korean Academy of Rehabilitation Medicine 2011;35(2):214-223.

Kim, Hye Ri , Kim, Keewon , Kim, Ho Geun , Lim, Chai Young , Chun, Se Woong , Seo, Kwan Sik

Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul 110-744, Korea. kurmguro@paran.com

Abstract

Objective
To evaluate the effect of stellate ganglion block (SGB) on the lymphoscintigraphic findings in patients with secondary lymphedema after breast cancer treatment. Method Fourteen patients were included in this retrospective study. Consecutive SGBs were performed three times, once every two weeks. The parameters for the lymphoscintigraphic findings included the extent of dermal backflow (small extent/large extent group), the presence of a washout pattern (washout/non-washout group) and visualization of lymph nodes on the 3-hour image (visualized/non-visualized group). The upper arm and forearm circumferences were used as the outcome parameters. We investigated the relationship between the lymphoscintigraphic findings and the arm circumferences.
Results
Regardless of the extent of dermal backflow, significant decreases of the upper arm and forearm circumferences were observed between the initial and final follow-up data. The small extent group showed a significant decrease of the forearm circumference at the first follow-up. The large extent group showed a pattern of significant decrease of the forearm circumference since the second follow-up. The washout group showed a decrease in both the upper arm and forearm circumferences, while the non-washout group showed a decrease only in the forearm circumference at the last follow-up. No difference was observed between the visualized and the non-visualized group. Conclusion The extent of dermal backflow and the presence of a washout pattern on lymphoscintigraphy showed correlation with the change of arm circumference. Lymphoscitigraphy prior to performance of SGB for lymphedema patients might be helpful to predict the outcome of SGB.

Key Words: Lymphedema, Lymphoscintigraphy, Stellate ganglion block