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Thoracic Outlet Syndrome: Is Scalene Block Predictive Of Surgical Success?
Dorcie Ann Gillette, MD, Linda Peng, Maen Aboul Hosn, MD.
University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
OBJECTIVES: Neurogenic thoracic outlet syndrome (nTOS) is a difficult pathology to accurately diagnose given the overlap between multiple causes of neuralgias of the upper extremity. One of the diagnostic studies that is currently available is the scalene block, which has been demonstrated to be a useful tool when evaluating whether the patient would benefit from thoracic outlet decompression. Our objective is to evaluate the predictive value of pre-operative scalene block for post-operative symptom improvement.
METHODS: A retrospective review was performed for all patients who underwent scalene block prior to a first rib resection and at our institution between 2018 and 2023. Data on demographics, presenting symptoms and preoperative workup were collected. Symptom resolution status following scalene block and after surgical decompression was collected based on chart reviews and direct patient contact. These were classified into three categories: complete resolution, partial resolution and no resolution.
RESULTS: Thirty-one patients underwent pre-operative scalene block prior to first rib resection. All patients experienced partial or complete improvement following the scalene block. Of these patients, twenty-one patients (68%) had complete improvement, eight patients (26%) had partial improvement, and two patients (6%) had no improvement following first rib resection. All patients that experienced only partial or no improvement from scalene blocks had greater than 50% improvement from pre-operative scalene blocks.
CONCLUSIONS: Neurogenic TOS is a complex pathology that is difficult to clinically diagnose. Based on our findings, pre-operative scalene block is an effective tool to accurately predict post-operative symptomatic improvement following first rib resection. The extent of predicted improvement remains variable and a harder measure to quantify given its subjective nature.
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