Combined Platelet Rich Plasma Intra-articular Shoulder Injection and Stellate Ganglion block, A new Technique for Management of Chronic Post-mastectomy Shoulder Pain Syndrome: A randomized Controlled Trial.

Abstract

Background: Adhesive capsulitis of the shoulder is common after breast cancer treatment. We aimed to compare the effects of using stellate ganglion block (SGB) with bupivacaine and ketamine alone versus its combined use with intra-articular platelet rich plasma (PRP) injection in patients with post-mastectomy shoulder pain. Methods: A prospective randomized open blinded end-point pilot study was conducted in Mansoura University Oncology Center, Egypt during the period from August 2017 till April 2018. Sixty-four patients with chronic post-mastectomy frozen shoulder were enrolled and allocated into one of two groups. Group A received ultrasound guided SGB with ketamine (0.5mg/kg) plus 5ml bupivacaine 0.5% and group B received ultrasound guided SGB using ketamine and bupivacaine in the same dose and intervals as group A plus posterior approach shoulder injection with PRP (3 times with 1-week interval). Numerical rating scale (NRS) at rest and at shoulder movement, range of motions (ROM) of shoulder and disability of arm, shoulder and hand (DASH) questionnaire were recorded. T-test and ANOVA test (for parametric data) and Mann-Whitny test, Wilcoxon rank test and Kruskal-Wallis test (for non-parametric data) were used for analysis. Results: Group B showed statistically significant improvement in NRS with shoulder movement and DASH score at one, two and three months after injection in comparison to group A (P≤0.001). Also, ROM improved significantly with PRP shoulder injection after one month from injection. Conclusion: The combination of intra-articular PRP injection with SGB using ketamine as adjuvant to bupivacaine produces dramatic improvement in post-mastectomy chronic shoulder pain. Their combined use reduces the need for analgesia.

Efficacy of platelet-rich plasma injection in the treatment of frozen shoulder: A systematic review and meta-analysis

“…Accordingly, potential studies were initially detected, and following a layer-by-layer screening, one prospective study and three randomized trials were included in the final quality assessment and data extraction. Of the four studies [17][18][19][20], three reported a VAS (n = 295) while three reported a ROM (n = 299). The literature screening process and results are shown in Fig.…”

“…Sequence generation and allocation were adequately reported by two studies [18,19], except for one study [17] where the concealment of allocation from the investigators and sequence generation was unclear (unclear risk of bias). Two studies [18,19] were considered at a low risk for detection bias because of the blinding of the outcome assessor, except for one study [17] in which the outcome assessor was not reported (unclear risk of bias). Patients in two studies [18,19] were blinded to their intervention group (low risk of bias), except for one study [17] in which the patients were not blinded to their intervention group (unclear risk of bias).…”

“…Two studies [18,19] were considered at a low risk for detection bias because of the blinding of the outcome assessor, except for one study [17] in which the outcome assessor was not reported (unclear risk of bias). Patients in two studies [18,19] were blinded to their intervention group (low risk of bias), except for one study [17] in which the patients were not blinded to their intervention group (unclear risk of bias). None of the studies reported significant loss of follow-up (low risk of bias).…”

Platelet-Rich Plasma for Adhesive Capsulitis: A Systematic Review

“…Barman et al [ 8 ] compared one injection of PRP to an injection of Methylprednisolone 2cc + 2cc of 2% Lidocaine. Ghaffar et al [ 25 ] compared three injections of PRP + Stellate Ganglion Block + Ketamine + 5 cc Bupivacaine 0.5% + 10 cc Saline to the same regimen without PRP. Kothari et al [ 7 ] looked at one injection of PRP with either an injection of 2 cc methylprednisolone or ultrasound therapy.…”

“…In terms of the control groups, Table 1 above shows the wide variation in control methods ranging from no intervention to injection of Stellate Ganglion Block + Ketamine + 5cc Bupivacaine 0.5% + 10cc Saline [ 25 ]. Multi-faceted control groups can make it hard to directly compare results.…”