Othman, A.H., & Zaky, A.H. (2014). Management of hot flushes in breast cancer survivors: Comparison between stellate ganglion block and pregabalin. Pain Medicine, 15, 410–417.

To compare stellate ganglion block and pregabalin in terms of efficacy and safety for the treatment of hot flashes in survivors of breast cancer

Patients were randomized to two groups. Stellate ganglion block at the anterolateral aspect of the C7 vertebra on the right side under fluoroscopy was done for 20 women experiencing hot flashes, and 20 other women received 75 mg pregabalin twice daily. Monthly symptom questionnaires were obtained at baseline and for the following three months.

• N = 40  
• MEAN AGE = 21 and older, with at least a six-month life expectancy
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Women with a diagnosis of breast cancer. All had received chemotherapy in the past. Subjects were not included in the study if they were currently receiving antineoplastic chemotherapy, androgens, estrogens, or progesterone analogs. The use of other agents for treating hot flashes, including vitamin E, antidepressants, or gabapentin, was not allowed prior to study initiation.
• OTHER KEY SAMPLE CHARACTERISTICS: Subjects experienced hot flashes for at least a month prior to study. They could receive tamoxifen, raloxifene, or aromatase inhibitors. No subject had a hysterectomy.

• SITE: Not stated/unknown    
• SETTING TYPE: Not specified    
• LOCATION: Not specified

• PHASE OF CARE: Late effects and survivorship

• Prospective single blind

All of the participants completed daily hot flash diaries that included four levels of severity of hot flashes (mild, moderate, severe, and very severe). The hot flash score was not selective to hot flashes at night or during the day; instead, it looked at the total number of hot flashes and their intensity during the 24-hour period. The side effects of pregabalin were assessed.

The stellate ganglion block group had a significant (p < 0.05) decline in the frequency of mild, moderate, and very severe levels and total hot flashes in comparison with the pregabalin 75 mg twice daily group during the three months of follow-up period.

During this study with a short follow-up of three months in a small group of subjects, stellate ganglion block had superior efficacy in the management of hot flashes in survivors of breast cancer.

• Small sample (less than 100)
• Measurement validity/reliability questionable 
• Findings not generalizable
• Intervention expensive, impractical, or training needs

Randomized trial exploring the effectiveness of stellate ganglion block and pregabalin suggests stellate ganglion is more effective in decreasing hot flashes. The sample size is small (n = 40); there is limited information about how the hot flash score was calculated.  Follow-up period was three months. More research on both interventions is needed.