Ganglion kistlerinin cerrahi tedavisinde farklı anestezik yaklaşımların nüks gelişimi üzerindeki etkileri

Abstract

Amaç: Ganglion kistlerinin cerrahi tedavisinde, uygulanan anestezi tipleri genellikle lokal anestezi (LA) ve Rejyonel Anestezi (RA) ile axiller blok uygulamaları olup bu anestezi tiplerinin cerrahi olarak tedavi edilen ganglion kistlerinde nüks gelişimi üzerindeki etkilerini göstermeyi amaçladık. Gereç ve Yöntem: 2017 -2019 yılları arasında kliniğimizde 142 hasta, el bileği dorsal ganglion kisti teşhisi konarak opere edildi. Dorsal bölge dışındaki kistler ile kontrollere en az 12 ay süreyle düzenli olarak gelmeyen hastalar çalışma dışı bırakıldı. Çalışmaya dahil edilen hasta sayısı 135 olup ortalama yaş 39.3 (15-73)tı. Ağrıyı tolere edebileceklerini belirten hastalara LA (Grup I), Ağrıyı tolere edemeyeceklerini ifade eden hastalara ise (GrupII) preop anestezi konsültasyonu istenerek, anestezistler tarafından RA uygulandı. Her iki grup hastaların dosyaları geriye dönük taranarak, anestezi tipinin nüks üzerindeki etkisi araştırıldı. Bulgular: RA grubunda nüks oranları LA grubundan istatistiksel olarak anlamlı derecede düşük bulunmuştur (p=0,049). LA grubunda nüks görülme riski RA grubundan 2,80 (0,95- 8,28) kat fazla bulunmuştur. RA grubunun operasyon Süresi ortalamaları lokal anestezi grubundan istatistiksel olarak anlamlı derecede düşük bulunmuştur (p=0,0001). Sonuç: RA’de; LA’ye kıyasla sağlanan daha derin ve daha uzun süreli anestezi ile beraber turnike uygulamasına imkan sağlanması, cerrahi konforu arttırarak kistin kısa sürede rahat bir şekilde disseksiyonuna ve tüm komponentlerin total eksizyonuna imkan sağlamaktadır.

Keywords

• Ganglionik kistler
• Cerrahi tedavi
• Lokal anestezi
• Benign tümörler
• Nüks

The effects of different anesthetic approaches on recurrence in the surgical treatment of ganglion cysts

Abstract

Aim: The surgical treatment of ganglion cysts usually involves local anesthesia (LA), regional anesthesia (RA), and axillary block applications. We aimed to show the effects of these anesthesia types on recurrence in surgically treated ganglion cysts. Material and Method: Between 2017-2019,142 patients were operated on in our clinic due to the dorsal ganglion cyst of the wrist. Cysts outside the dorsal region and patients who did not regularly attend their follow-up visits for at least 12 months were excluded. One hundred and thirty-five patients, with a mean age of 39.3 (15-73) years, were included in the study. LA (Group I) was applied to the patients who stated that they could tolerate the pain, and RA was used on those who stated that they could not (Group II) after preoperative anesthesia consultations. The files of the patients in both groups were reviewed retrospectively, and the effect of anesthesia type on recurrence was investigated. Results: Recurrence rates were significantly lower in the RA group compared to those in the LA group (p=0.049). The risk of recurrence in the LA group was 2.80 (0.95-8.28) times higher than in the RA group. The mean operation time of the RA group was significantly lower than that of the local anesthesia group (p=0.0001). Conclusion: The fact that RA allows tourniquet applications with deeper and longer-lasting anesthesia compared to LA increases surgical comfort and makes way for the comfortable dissection of the cyst and total excision of all components within a short operative time.

Keywords

• Benign Tumors
• Ganglionic cyst
• Surgical Treatment
• Lokal Anesthesia
• Recurrence

References

1. Meena S, Gupta A. Dorsal wrist ganglion: Current review of literature. J Clin Orthop Trauma 2014; 5:59-64.
2. Gude W, Morelli V. Ganglion cysts of the wrist: pathophysiology, clinical picture, and management. Curr Rev Musculoskelet Med 2008; 1: 205-11.
3. Kissel JA, Wong C. Ganglion cyst of the wrist treated with electroacupuncture: a case report. J Can Chiropr Assoc 2017 ; 61: 269-276.
4. Gregush RE, Habusta SF. Ganglion Cyst. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
5. Akman Ş, Gür B, Sülün T, Aksoy B.A. Case of a ganglion cyst originating from the hip joint and surgical outcome. Acta Orthop Traumatol Turc 2002; 36: 76-8.
6. Medina J, Rivlin M, Chan J, Beredjiklian PK. Ossified dorsal wrist ganglion cyst: a case report. Arch Bone Jt Surg 2016; 4: 399-401.
7. Lyon C, Eldred SV, Desanto K. What is the best treatment for wrist ganglion cyst? J Fam Pract 2020; 69: E23-E24.
8. Khubaib MU, Monaco R. Unigue Location and orijin of Ganglion cyst. Cureus 2021;13: e16453.

9. Pang EQ, Zhang S, Harris AHS, Kamal RN. Cost minimization analysis of ganglion cyst excision. J Hand Surg 2017; 42:750.e1-750.e4.
10. Gant J, Ruff M, Janz BA. Wrist Ganglions. J Hand Surg Am 2011; 36: 510-2.
11. Eriksen JH, Konig MJ, Balslev E, Soe NH. Ganglion cyst on wrist and hand. Ugeskr Laeger 2022;184: V05210428.
12. Head L, Gencarelli JR, Allen M, Boyd KU. Wrist ganglion treatment: systematic review and meta-analysis. J Hand Surg 2015; 40: 546–53.
13. Mooney ML, Jacobs CA, Prusick VW, Riley SA. Pediatric ganglion cyst recurrence: location isn’t the only risk factor. J Pediatr Orthopaedics 2020; 40: 340–3.
14. Bram JT, Falk DP, Chang B, et al. Clinical Presentation and Characteristics of Hand and Wrist Ganglion Cysts in Children. J Hand Surg 2021; 46:1122.e1-1122.e9.
15. Suen M, Fung B, Lung CP. Treatment of ganglion cysts. ISRN Orthop 2013; 28: 940615
16. Trivedi NN, Schreiber JJ, Daluiski A. Blunt Force May be an Effective Treatment for Ganglion Cysts. HSS J 2016;12:100-4.
17. Chaudhary S, Mandal S, Kumar V. Results of modified thread technique for the treatment of wrist ganglion. J Clin Orthop Trauma 2020;13:57-62.
18. Oztermeli A, Yılmaz B, Kömür B, et al. Recurrence is Unavoidable in Hand and Wrist Ganglion Cyst Surgery.Van medical journal 2022; 29: 224-8.
19. Meyerson J, Pan YL, Spaeth M, Pearson G. Pediatric Ganglion Cysts: A Retrospective Review. Hand (NY) 2019;14: 445-8.
20. Sinha MK, Mishra P, Mishra TS, Barman A. Aspiration and steroid injection in ganglion cysts: An ultrasound guided evaluation of the response. J Clin Orthop Trauma 2019;10: 252-7.
21. Graham JG, McAlpine L, Medina J, Jawahier PA, Beredjiklian PK, Rivlin M. Recurrence of Ganglion Cysts Following Re-excision. Arch Bone Jt Surg 2021; 9:387-390.