Evaluation of the role of preservation of the intercostobrachial nerve on the post-mastectomy pain syndrome in breast cancer patients of North India

Background: Post-mastectomy pain syndrome (PMPS) is experienced by 20-65% of the patients who undergo breast surgery for cancer. The etiology of this chronic neuropathic pain syndrome is still poorly understood and supposed to be multi-factorial. Intercostobrachial (ICB) nerve injury is supposed to be the main cause of the PMPS. Objectives: This retrospective study was designed to evaluate the role of preservation of the intercostobrachial nerve and post-mastectomy pain syndrome and also to evaluate various anatomical variations of the intercostobrachial nerve in our breast cancer patients.Method: The assessment was done subjectively by specific pain questionnaire and objectively by neurological examination for neuropathic pain and sensitivity alternations.Ninety-one patients were included in this retrospective study. Later on, 22 patients were excluded, mainly because of advanced stage of breast cancer. Forty-two patients were included into the ICB nerve preservation group A. In Group B, 27 patients were included where this nerve was sectioned. In all the cases, it was tried to identify the nerve and its course at the best to assess various variations.The subjective and objective pain evaluations were performed on the 2 day, after 1 month and after 3 months post-operatively.Results: After 3 months, 76.2% of the patients were asymptomatic in Group A (ICB nerve preservation group) and 51.9% in the nerve section group (Group B) (p<.01). Although there was a slight increase in the total time of surgery in group A, it was not significant (p=0.62) and there was also no significant difference in the numbers of axillary lymph nodes dissected between the two groups.At surgical dissection, we found that 69.6% of patients (48/69) were having Type1 variation, followed by Type 2 (18.8%) and Type 3 (5.8%).We didn’t find any variation of Type 5 in the course of the ICB nerve during axillary dissection.Conclusion: So it is concluded that the preservation of ICB nerve leads to significant decrease in the occurrence of post-mastectomy pain syndrome. To preserve the ICB nerve, the knowledge of the variations of this nerve is very important for the surgeons.