Çocuklarda inguinal herni onarımı sonrası kronik ağrı
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Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Cerrahi sonrası kronik ağrı (CSKA) cerrahi girişimden 3 ay sonra halen devam eden ağrı olarak tanımlanır. Prevalansı, cerrahinin tipine göre değişkenlik göstermektedir. Yetişkin olgularda CSKA insidansı; amputasyonlarda %50-85 arasında, torakotomi sonrasında %20-60 arasında, mastektomi sonrası %30, inguinal herni onarımı sonrası ise %10 olarak bulunmuştur. Çocuk hastalarda yapılan çalışmalarda, CSKA insidansının daha düşük olduğu bildirilmiştir. Bunun nedeni olarak çocuklarda iyileşmenin daha hızlı, cerrahi prosedürlerin daha basit, kemik-tendon ve ligamentlerin daha esnek olması gösterilmiştir. İnguinal herni onarımı erişkin yaş grubu kadar çocuklarda da sık uygulanan bir operasyon türüdür. Çocuklarda yapılan sınırlı sayıda çalışmada inguinal herni onarımı sonrası CSKA insidansı %2-5 olarak bulunmakla birlikte erişkinden (%10) daha düşük orandadır. Çalışmamıza Üniversitemiz Çocuk Cerrahisi Anabilim Dalı Ameliyathanesi’nde inguinal herni onarımı planlanan 2-12 yaş arası 100 olgu dahil edildi. Tüm olgularda cerrahi girişim standard genel anestezi altında (%2-3 sevofluran ve 0.25 mcg/kg/dk remifentanil) gerçekleştirildi. İndüksiyonda 0.5 mg/kg ketamin IV ve 0.5 mg/kg deksametazon IV, operasyon sonunda 15 mg/kg parasetamol IV uygulandı. Ayrıca operasyon bitiminde insizyon yerine lokal anestezik infiltrasyonu (1 mg/kg bupivakain) yapıldı. Ağrı postoperatif 1. ay, 2. ay ve 3.ayda değerlendirildi. Ağrının varlığı ve şiddetinin değerlendirilmesinde çocuk ile birlikte çocuğun bakımından sorumlu birinci derece yakınının doldurduğu Wong-Baker Face Skalası ve Vizüel Anolog Skala (VAS) kullanıldı.Çalışmayı 76 olgu (63 erkek/23 kız) tamamladı. Olguların yaş ortalaması 5.3 yıl idi. Bu operasyonların 19’u laporoskopik, 57’si açık cerrahi olarak gerçekleştirildi. 41 olguda sağ taraf, 24 olguda sol taraf ve 11 olguda bilateral onarım uygulandı. 1. ay, 2. ay ve 3. ayda yapılan postoperatif ağrı değerlendirmesinde olguların hiç birinde ağrı bildirimi olmadı. Çalışmamızda pediatrik inguinal herni onarım sonrası CSKA gelişmemesinde perioperatif multimodal analjezi yaklaşımının önemli rol oynadığı kanısına varıldı.
Chronic postsurgical pain (CPSP) is defined as ongoing pain 3 months after surgery. Its prevelance varies in different surgical types. The prevelance of adult CPSP is between 50% - 85% after amputations, between 20% - 60% after thoracotomy, 30% after mastectomy, 10% after inguinal hernia repair. Studies in children have reported a lower incidence of CPSP in this group of patients. The reason for this was considered as faster healing in children, simpler surgical procedures, and less damage due to bone, tendon and ligaments being more flexible. Inguinal hernia repair is a common type of operation that is used in children as well as in adults. In a limited number of studies in children, the incidence of CPSP after inguinal hernia repair is 2-5%, which is lower than that of the adults. In our study, 100 children (aged between 2 and 12 years) underdoing inguinal hernia repair in the Department of Pediatric Surgery, Ege University were included. The surgical procedures were performed under standard general anesthesia (2-3% sevoflurane and 0.25 mcg/kg/min remifentanil) in all cases. Ketamine 0.5 mg/kg IV and dexamethasone 0.5 mg/kg IV were administered at induction and parasetamol 15 mg/kg IV was given at the end of the operation. In addition, local anesthetic (bupivacaine 1 mg/kg) was infiltrated at the operation site at the end of the operation. Pain assessment was performed at postoperative 1st month, 2nd month and 3rd months. The Wong-Baker Face Scale and Visual Anolog Scale (VAS), in which the child filled with the first degree relative responsible for the child's care, were used to assess the presence and severity of pain. 76 cases (63 boys/23 girls) completed the study. Their mean age was 5.3 years. 19 of these operations were performed laparoscopically and 57 were open surgery. Right side in 41 cases, left side in 24 cases and bilateral repair in 11 cases were performed. In the postoperative pain assessments performed at the 1st, 2nd, and 3rd months, none of the children reported any pain. We concluded that peri-operative multimodal analgesia might be an important factor for the absence of CPSP in children undergoing inguinal hernia repair in our study.
Chronic postsurgical pain (CPSP) is defined as ongoing pain 3 months after surgery. Its prevelance varies in different surgical types. The prevelance of adult CPSP is between 50% - 85% after amputations, between 20% - 60% after thoracotomy, 30% after mastectomy, 10% after inguinal hernia repair. Studies in children have reported a lower incidence of CPSP in this group of patients. The reason for this was considered as faster healing in children, simpler surgical procedures, and less damage due to bone, tendon and ligaments being more flexible. Inguinal hernia repair is a common type of operation that is used in children as well as in adults. In a limited number of studies in children, the incidence of CPSP after inguinal hernia repair is 2-5%, which is lower than that of the adults. In our study, 100 children (aged between 2 and 12 years) underdoing inguinal hernia repair in the Department of Pediatric Surgery, Ege University were included. The surgical procedures were performed under standard general anesthesia (2-3% sevoflurane and 0.25 mcg/kg/min remifentanil) in all cases. Ketamine 0.5 mg/kg IV and dexamethasone 0.5 mg/kg IV were administered at induction and parasetamol 15 mg/kg IV was given at the end of the operation. In addition, local anesthetic (bupivacaine 1 mg/kg) was infiltrated at the operation site at the end of the operation. Pain assessment was performed at postoperative 1st month, 2nd month and 3rd months. The Wong-Baker Face Scale and Visual Anolog Scale (VAS), in which the child filled with the first degree relative responsible for the child's care, were used to assess the presence and severity of pain. 76 cases (63 boys/23 girls) completed the study. Their mean age was 5.3 years. 19 of these operations were performed laparoscopically and 57 were open surgery. Right side in 41 cases, left side in 24 cases and bilateral repair in 11 cases were performed. In the postoperative pain assessments performed at the 1st, 2nd, and 3rd months, none of the children reported any pain. We concluded that peri-operative multimodal analgesia might be an important factor for the absence of CPSP in children undergoing inguinal hernia repair in our study.
Açıklama
Anahtar Kelimeler
Çocuk, Cerrahi Sonrası Kronik Ağrı, Postoperatif Ağrı, İnguinal Heni, Children, Chronic Postsurgical Pain, Postoperative Pain, Inguinal Hernia
