Revista Brasileira de Ginecologia e Obstetrícia (Jun 2007)
Avaliação clínica da dor e sensibilidade cutânea de pacientes submetidas à dissecção axilar com preservação do nervo intercostobraquial para tratamento cirúrgico do câncer de mama Clinical evaluation of pain and cutaneous sensitivity in patients with preservation of intercostobrachial nerve during the axillary dissection for breast cancer treatment
Abstract
OBJETIVO: avaliar a dor e a sensibilidade cutânea superficial no dermátomo do nervo intercostobraquial (NICB) em pacientes submetidas à dissecção axilar com preservação do NICB para tratamento cirúrgico do câncer de mama. MÉTODOS: realizamos estudo tipo coorte prospectivo de 77 pacientes divididas em Grupo NP (n=34), sem preservação do NICB, e Grupo ICB (n=43), com preservação do NICB. A sensibilidade cutânea foi avaliada um ano após a cirurgia, empregando-se: 1) questionário modificado de McGill; 2) exame clínico incluindo perimetria braquial, pesquisa de sensibilidade táctil e dolorosa; 3) aplicação dos monofilamentos de Semmes-Weinsten que permitem avaliar de forma objetiva, qualitativa e quantitativamente, lesões de nervo periférico. Para análise estatística, foram usados os testes do chi2, Kruskal-Wallis e exato de Fisher. RESULTADOS: a dor foi relatada com maior freqüência pelas pacientes do Grupo NP (23/33) do que pelas pacientes do Grupo ICB (17/42); p=0,012. A sensibilidade dolorosa estava preservada na maioria das pacientes do Grupo ICB (38/42) e em apenas 11/33 do Grupo NP (pPURPOSE: loss of cutaneous sensitivity has been related to lesions of the intercostobrachial nerve (ICBN) during the axillary lymph node dissection for breast cancer treatment. We evaluated pain and cutaneous sensitivity in the ICBN dermatome of patients in which the nerve was preserved during the axillary dissection. METHODS: we carried out a prospective cohort study of 77 patients divided into: NP group (n=34), patients without ICBN preservation, and ICB group (n=43), patients in which the nerve was preserved. Cutaneous sensitivity was evaluated one year after surgery using 1) a modified McGill Pain Questionnaire; 2) clinical examination including brachial perimetry and evaluation of pain and tactile sensitivity; 3) Semmes-Weinstein monofilaments which allow an objective, qualitative, and quantitative evaluation of peripheral nerve lesions. RESULTS: pain was more frequently reported in the NP group (23/33) than in patients from the ICB group (17/42); p=0,012. Painful sensitivity was preserved in the majority of patients from the ICB group (38/42) but in only 11/33 patients from the NP group (p<0,01). There was no significant difference in the number of lymph nodes dissected between the two groups (p=0,06). CONCLUSIONS: patients with ICBN preservation had less pain and more preservation of cutaneous sensitivity, with no decreased number of axillary lymph nodes removed during the axillary dissection.
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