Geçirilmiş cerrahi müdahale sonrası fibromyalji sendromu tanısı alan hastalarda cerrahi skar dokularına uygulanan lokal anestezik enjeksiyonunun etkisinin değerlendirilmesi

Öz

Amaç: Geçirilmiş cerrahi müdahale sonrası fibromyalji sendromu (FMS) tanısı alan hastalarda fizik tedaviye ek olarak skar dokularına lidokain enjeksiyonunun ağrı, depresyon ve fonksiyonel durumuna olan etkilerinin değerlendirilmesi amaçlandı.  

Materyal ve Metod: Retrospektif çalışmaya 117 hasta (108 kadın, 9 erkek) arasından, FMS tanısı konulmadan önce cerrahi operasyon geçirdiği saptanan 54 hasta (52 kadın, 2 erkek) içinde tedavileri tamamlanan 45 kadın hasta çalışmaya dahil edildi. Hastalar fizik tedavi (FT) alanlar ve fizik tedaviye ek skar dokularına lidokain enjeksiyonu yapılan hastalar (FT+lidokain) olarak ayrıldı.

Tüm hastalara 15 seans boyun/sırt bölgelerine FT uygulanmıştı (sıcak paket+TENS+terapötik ultrason). Lidokain enjeksiyonu 3 haftada 6 seans, ortalama 1 cm² skar dokusuna % 0.5’ lik 0.7 cc lidokain olacak şekilde uygulanmıştı. Değerlendirme parametreleri; ağrı ve sabah tutukluğu [görsel analog skala (GAS)], hassas nokta sayısı, depresyon düzeyi [Beck Depresyon ölçeği (BDÖ)], fonksiyonel değerlendirme [Fibromiyalji Etki Ölçeği (FEÖ)] idi. Tedavi öncesi, tedavi sonrası veriler ve tedavi sonrası 4-6 hafta sonra yapılan değerlendirmeler kaydedildi.

Bulgular: Çalışma FT alan 22, FT+enjeksiyon alan 23, toplam 45 olgu ile tamamlandı. Olguların hepsi kadındı, yaş ortalaması 40,69±5,51 yıldı.

Tedavi öncesinde gruplar arasında demografik ve klinik değerlendirmeler açısından anlamlı fark yoktu (p>0,05). Grup içi değerlendirmelerde iki grupta tüm parametrelerde anlamlı düzelme saptandı (p<0,01).

Gruplar arası karşılaştırma değişim farkları değerlendirildiğinde ağrı, sabah tutukluğu, BDÖ, FEÖ FT+Lidokain grubunda FT grubuna göre anlamlı olarak değişti. (p<0,01)

Sonuç: Geçirilmiş cerrahi müdahale sonrası fibromyalji sendromu (FMS) tanısı alan kadın hastalarda hem FT, hem FT+lidokain tedavisi etkili tedavilerdir. FT+lidokain uygulanan hastalarda tedavi ile sağlanan değişim ağrı, sabah tutukluğu şiddeti, depresyon ve fonksiyonel durum açısından FT grubuna göre daha anlamlı iyilik sağladı.

Anahtar Kelimeler

• Fibromiyalji,lidokain,skar

Evaluation of the effect of local anesthetic injection on surgical scar tissues in patients diagnosed with fibromyalgia syndrome after surgical intervention

Abstract

Introduction: The aim of this study was to evaluate the effects of lidocaine injection to scar tissues in addition to physical therapy on pain, depression and functional status in patients diagnosed with fibromyalgia syndrome (FMS) after surgery.

Method: In this retrospective study, 45 female patients who completed their treatment out of 54 patients (52 females, 2 males) who were found to have undergone surgery prior to the diagnosis of FMS out of 117 patients (108 females, 9 males) were included. Patients were divided into groups of physical therapy (PT) and lidocaine injection  to scar tissues in addition to physical therapy (PT + lidocaine).

All patients underwent PT (hot pack + TENS + therapeutic ultrasound) for 15 sessions to neck / back areas. Lidocaine injection was performed 6 sessions in 3 weeks, with an average of 0.7 cc of  %0.5 lidocaine to 1 cm2 scar tissue. Evaluation parameters; pain and morning stiffness [visual analogue scale (VAS)], number of sensitive points, depression level [Beck Depression Inventory (BDI)], functional evaluation [Fibromyalgia Impact Questionnaire (FIQ)]. Pre- and post-treatment data and data 4-6 weeks after treatment were recorded.

Results: The study was completed with 22 of PT, 23 of PT + injection, total 45 cases. All cases were women, with a mean age of 40.69 ± 5.51 years.

There was no significant difference between the groups in terms of demographic and clinical parameters before the treatment (p> 0.05). Significant improvement was found in all groups for all parameters (p <0.01).

When the differences between the groups were compared, pain, morning stiffness, BDI, FIQ in  PT + Lidocaine group were significantly changed compared to the PT group (p <0.01).

Conclusion: Both PT and PT + lidocaine treatment are effective treatments in women with fibromyalgia syndrome (FMS). In patients who underwent PT + lidocaine, the treatment modality provided more significant well-being than the PT group in terms of pain, severity of morning stiffness, depression and functional status.

Keywords

• Fibromyalgia,lidocaine,scar

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