Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
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The Effect of Stellate Ganglion Block on Breast Cancer-Related Infectious Lymphedema

유방암 감염성 림프부종 환자에서 성상신경절 블록이 미치는 영향

  • Lee, Youn Young (Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine) ;
  • Park, Hahck Soo (Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine) ;
  • Lee, Yeon Sil (Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine) ;
  • Yoo, Seung Hee (Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine) ;
  • Lee, Heeseung (Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine) ;
  • Kim, Won Joong (Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine)
  • 이윤영 (이화여자대학교 의과대학 마취통증의학교실) ;
  • 박학수 (이화여자대학교 의과대학 마취통증의학교실) ;
  • 이연실 (이화여자대학교 의과대학 마취통증의학교실) ;
  • 유승희 (이화여자대학교 의과대학 마취통증의학교실) ;
  • 이희승 (이화여자대학교 의과대학 마취통증의학교실) ;
  • 김원중 (이화여자대학교 의과대학 마취통증의학교실)
  • Received : 2018.06.27
  • Accepted : 2018.11.01
  • Published : 2018.12.01
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Abstract

Breast cancer related lymphedema (BCRL) is one of the most intractable complications after surgery. Patients suffer from physical impairment, as well as psychological depression. Moreover, a recent study revealed that cellulitis significantly increased the risk of BCRL, and cellulitis has been suggested as a risk factor of BCRL development. We describe a patient treated with stellate ganglion blocks (SGBs) without steroid for relief of symptoms and reduction of the arm circumference of breast cancer-related infectious lymphedema in a month. We measured the arm circumference at four locations; 10 cm and 5 cm above and below the elbow crease, numeric rating scale (NRS) score, lymphedema and breast cancer questionnaire (LBCQ) score on every visit to the pain clinic. A serial decrease of the arm circumference and pain score were observed after second injection. In the middle of the process, cellulitis recurred, we performed successive SGBs to treat infectious lymphedema. The patient was satisfied with the relieved pain and swelling, especially with improved shoulder range of motion as it contributes to better quality of life. This case describes the effects of SGB for infectious BCRL patients. SGB could be an alternative or ancillary treatment for infectious BCRL patients.

유방암에 의한 림프부종은 유방암 수술 이후 생기는 치료하기 힘든 부작용 중 하나로 여겨져 왔다. 환자들은 림프부종에 의한 신체적인 기능저하뿐만 아니라 삶의 질 저하로 인한 정신적인 우울감을 호소한다. 최근의 연구에서는 봉와직염이 유방암에 의한 림프부종의 위험성을 현저히 높인다는 결과가 있었고, 봉와직염 자체가 유방암에 의한 림프부종을 일으키는 위험 인자로 제시되어 왔다. 본 증례에서는 1달간의 성상신경절 블록으로 유방암에 의한 염증성 림프부종 환자의 증상 완화 및 팔 둘레의 현저한 감소에 대해 기술 하고자 한다. 우리는 환자의 팔 둘레를 4군데에서 측정하였는데 각각 팔꿈치를 기준으로 위 아래 5 cm, 10 cm에서 측정이 이루어졌다. 또한 통증 점수(NRS) 와 breast cancer questionnaire (LBCQ) 점수를 외래 방문마다 측정하였다. 두 번의 연속적인 성상신경절 블록 이후 환자의 통증 점수 및 팔 둘레는 감소하였고, 치료 중간에 봉와직염이 재발하여 다시 입원하여 항생제 치료와 병행하여 연속적인 성상신경절 블록을 시행하였고 환자는 시술의 결과에 대해 매우 만족하였다. 특히 환자는 통증 및 붓기의 완화와 어깨 관절의 움직임 개선에 큰 만족을 보였고, 결과적으로 환자의 삶의 질을 높이는데 기여하였다. 본 증례는 유방암에 의한 염증성 림프부종에 대한 성상신경절 블록의 효과에 대한 연구로, 스테로이드를 사용하지 않는 성상신경절 블록이 치료하기 힘든 염증성 림프부종 환자의 대체적이면서 보조적인 치료 방법으로 제시 될 수 있다는 것을 보여준다.

Keywords

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