Impact of anterior scalene lidocaine blocks on predicting surgical success in older patients with neurogenic thoracic outlet syndrome

Abstract

Although patients with NTOS < 40 years old achieve more symptom relief overall after transaxillary decompression as compared to patients ≥ 40 years old, the selective use of lidocaine blocks is more beneficial in predicting surgical success in patients ≥ 40 years old given that younger patients < 40 years old seem to do well regardless.

Diagnosis and Treatment of Thoracic Outlet Syndrome

“…For both diagnostic and therapeutic purposes, some practitioners advocate percutaneous neuromuscular blockade of the anterior scalene, middle scalene, pectoralis minor and subclavius muscles [39]. By inducing transient or long-lasting paralysis of these muscles, the interscalene triangle and costoclavicular space widen.…”

“…Nerve conduction studies Needle electromyography [5,34] Local anaesthetic injection test [5,[35][36][37][38] -MR neurography [39,40] Diffusion tensor imaging [41][42][43][44][45] Brachial plexus ultrasound [46,47] When it comes to supporting the suspected diagnosis, the mainstays of tests in ATOS are duplex ultrasound, arteriography, haemodynamic testing (e.g., finger plethysmography) at rest, and, with provocative manoeuvres, CT angiography and MR angiography [5]. Invasive arteriography and angiography are for detecting complications of ATOS such as thrombosis, embolisation, and aneurysm.…”

Thoracic outlet syndromes in sport: a practical review in the face of limited evidence — unusual pain presentation in an athlete

“…There appears to be a lack of objective diagnostic criteria 10. There is described in the literature a collection of symptoms considered to be ‘true NTOS’ and these include weakness in the thenar, hypothenar and interossei with or without atrophy, as well as ulnar and medial antebrachial cutaneous hypaesthesia of the ipsilateral arm.…”

“…One paper referenced that opioid use in patients with NTOS was 29% in their sample of 87 32. The most significant discussion in the literature is the use of scalene blocks in NTOS, although many papers advocate their use as a diagnostic tool or predictor of operative success, rather than for pain management 10 14 32–36. One article in 2011 discusses the practices of a single clinician, who advises the use of a long-acting opioid in combination with a long-acting non-steroidal anti-inflammatory 37…”

“…The patient intended to rest for one month but symptoms worsened after two weeks rest, leaving surgery as a more viable option. Most literature describes the conservative route as being the recommended initial form of treatment 10 18 32 38–41…”