الفهرس 
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Abstract
Introduction: There is no standardized definition for post mastectomy pain syndrome , however it has been described as a type of neuropathic pain, commonly associated with nerve fiber injury. Pain is typically localized to the anterior and lateral chest wall, axilla, and/or medial upper arm and persists more than 3 months after surgery. Studies estimate that PMPS develops in 25 to 60% of women leading to disability, psychological distress, and diminished quality of life. Aim of this study: To compare analgesic efficacy and duration of stellate ganglion block when using both dexamethasone and magnesium sulfate with the local anesthetic lidocaine in comparison to using dexamethasone alone with lidocaine in cases of post mastectomy pain syndrome. Patients and methods: Patients underwent elective breast surgery (modified radical mastectomy) and referred to pain clinic with post mastectomy pain from September 2019 to September 2020. Methods: This study was conducted at outpatient pain clinic at OCMU on 50 female patients between 20 and 60 years, underwent modified radical mastectomy and had chronic neuropathic pain lasting more than 6 months following mastectomy. Exclusion criteria include: patient refusal, coagulopathy, neuromuscular diseases, infection, and allergy yo any of the drugs used.US guided stellate ganglion block was done by using magnesium sulfate, dexamethasone, lidocaine in one group, dexamethasone and lidocaine only in the other group. Results: VAS score was lower in magnesium group than the other group, time to first request of analgesia was longer, and total amount of amount of analgesia needed was lower in magnesium group than the other group. By analyzing and processing the results obtained our study we concluded that: adding of 100 mg of magnesium sulfate to lidocaine and dexamethasone for ultrasound guided stellate ganglion block in patients of post mastectomy pain syndrome increases the time to first request of analgesia , decreases VAS values and the total amount of co-analgesia (gabapentin dose) needed in three months after the block compared to using lidocaine and dexamethasone alone. Furthermore, magnesium sulfate provides better quality of the block.