Total kalça artroplastisi uygulanan hastalarda postoperatif şiddetli ağrı ile ilişkili faktörler

Year 2014, Volume: 48 Issue: 6, 615 - 622, 16.01.2015

Nadezda M. Petrovic Dragan R. Milovanovic Dragana İgnjatovic Ristic Nikola Riznic Branko Ristic Zeljko Stepanovic

https://doi.org/10.3944/AOTT.2014.14.0177

Abstract

Amaç: Bu çalışmada, total kalça artroplastisi sonrası, özellikle psikolojik sıkıntı ve kişilik özellikleri ile bağlantılı gelişebilecek postoperatif ağrıya dair risk faktörlerinin belirlenmesi amaçlandı.

Çalışma planı: Çimentolu total kalça replasmanı sonrası postoperatif ağrı şikayeti ile başvuran 90 hasta, sayısal değerleme ölçeği (SDÖ) ile ölçülen ağrının şiddetine göre iki gruba ayrıldı. SDÖ puanı 5 veya daha yüksek olan hastalar çalışma grubuna, 5 puanın altında kalan hastalar ise kontrol grubuna dahil edildi. Psikolojik değerlendirmede, anksiyete ve depresyon için Hamilton ölçekleri, Tip D kişiliğin saptanması için ise DS14 testinden yararlanıldı.

Bulgular: Çalışma grubundaki bireylerin çoğunluğu kadındı ve anksiyete, depresyon semptomları ve Tip D kişilik özellikleri saptanan olguların kontrol grubuna kıyasla daha yüksek sayıda olduğu belirlendi (sırasıyla, 13’e karşı 3, 11’e karşı 2 ve 18’e karşı 9 olgu). Cerrahi öncesi ortalama SDÖ puanı çalışma grubunda kontrol grubunda ise olarak bulundu (p<0.001). Postoperatif ağrı gelişimiyle ilişkilendirilen faktörler kadın cinsiyet (OO=4.91, %95 GA=2.01-12.01, p<0.001), Tip D kişilik (OO=2.81, GA=1.17-7.32, p=0.030), şiddetli anksiyete (OO=6.01, GA=1.58-22.90, p=0.009), depresif semptomlar (OO=7.33, GA=1.52-35.34, p=0.013) ve cerrahi öncesi dikkat çekici derecede ağrısı bulunan olgular (OO=2.64, GA=1.17-5.44, p<0.001) oldu.

Çıkarımlar: Şiddetli anksiyete, depresyon ve Tip D kişilik özelliklerine sahip olgularda şiddetli postoperatif ağrı görülme riski bulunmaktadır. Bunlar dışında, kadın cinsiyet ve cerrahiden hemen sonraki ağrı şiddetinin de önemli risk faktörleri olduğu belirlenmiştir.

Keywords

Anksiyete; depresyon; kadın; postoperatif ağrı; risk faktörleri; Tip D kişilik; total kalça artroplastisi.

Factors associated with severe postoperative pain in patients with total hip arthroplasty

Abstract

Objective: The aim of this study was to determine the risk factors for the development of postoperative pain following total hip arthroplasty, particularly those connected with psychological distress and personality traits.

Methods: The study included 90 patients with complaints of postoperative pain following cemented total hip replacement divided into two groups based on the intensity of postoperative pain as measured using the numerical rating scale (NRS). Patients with NRS scores of 5 or higher were included in the study group and those with NRS of less than 5 were included in the control group. The Hamilton scales for anxiety and depression and the DS14 test for the identification of Type D personality were used for psychological evaluation.

Results: In the study group, more patients were female (29 vs. 13) and had more anxiety (13 vs. 3), depression symptoms (11 vs. 2), and Type D personality (18 vs. 9) than the control group. Mean preoperative NRS was 7.2±1.7 in the study and 6.0±1.2 in the control group (p<0.001). Factors associated with development of strong postoperative pain was female gender (OR=4.91, 95% CI=2.01 to 12.01, p<0.001), Type D personality (OR=2.81, CI=1.17 to 7.32, p=0.030), severe anxiety (OR=6.01, CI=1.58 to 22.90, p=0.009), depressive symptoms (OR=7.33, CI=1.52 to 35.34, p=0.013) and subjects with marked preoperative painful condition (OR=2.64, CI=1.17 to 5.44, p<0.001).

Conclusion: Patients with severe anxiety, depression and Type D personality appear to be at risk of developing severe postoperative pain. In addition, female gender and the intensity of pain immediately after procedure were found to be important risk factors.

Keywords

Anxiety, depression, female, postoperative pain, risk factors, total hip arthroplasty, Type D personality

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