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Neural Blockade for Persistent Pain After Breast Cancer Surgery
  1. Nelun Wijayasinghe, MBBS, BSc, FRCA,
  2. Kenneth G. Andersen, MD and
  3. Henrik Kehlet, MD, PhD
  1. Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  1. Address correspondence to: Nelun Wijayasinghe, MBBS, BSc, FRCA, Section for Surgical Pathophysiology 4074, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (e-mail: nelun.wijayasinghe{at}


Abstract Persistent pain after breast cancer surgery is predominantly a neuropathic pain syndrome affecting 25% to 60% of patients and related to injury of the intercostobrachial nerve, intercostal nerves, and other nerves in the region. Neural blockade can be useful for the identification of nerves involved in neuropathic pain syndromes or to be used as a treatment in its own right. The purpose of this review was to examine the evidence for neural blockade as a potential diagnostic tool or treatment for persistent pain after breast cancer surgery. In this systematic review, we found only 7 studies (n = 135) assessing blocks directed at 3 neural structures—stellate ganglion, paravertebral plexus, and intercostal nerves—but none focusing on the intercostobrachial nerve. The quality of the studies was low and efficacy inconclusive, suggesting a need for well-designed, high-quality studies for this common clinical problem.

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  • The authors declare no conflict of interest.

    This study was funded by a grant from the Danish Cancer Society and the study is part of the European Collaboration, which has received support from the Innovative Medicines Initiative Joint Undertaking, under grant agreement no. 115007, resources which are composed of financial contributions from the European Union’s Seventh Framework Programme (FP7/2007-2013) and EFPIA companies in kind contribution.