Sezaryen hastalarında trunkal blokların kronik postoperatif ağrı üzerine etkisinin değerlendirilmesi: retrospektif kohort çalışması

Abstract

Amaç: Kronik postoperatif ağrı (CPSP), sezaryen sonrası giderek daha fazla tanınan bir komplikasyondur ve maternal yaşam kalitesi üzerinde olumsuz etkiler yaratabilir. Etkin postoperatif analjezinin CPSP riskini azaltmada rol oynayabileceği öne sürülmektedir. Bu çalışmanın amacı, spinal anestezi altında yapılan sezaryen operasyonları sonrasında multimodal analjezi kapsamında uygulanan fasyal plan bloklarının CPSP insidansı ve karakteristikleri üzerindeki etkisini değerlendirmektir. Yöntem: Bu retrospektif, tek merkezli kohort çalışmaya, Ocak 2024 ile Mart 2025 tarihleri arasında spinal anestezi altında elektif sezaryen operasyonu geçiren, 18–40 yaş aralığında ve tekil gebeliğe sahip kadınlar dahil edildi. Hastalar iki gruba ayrıldı: anterior quadratus lumborum bloğu (QLB) veya ilioinguinal–iliohipogastrik (II-IH) sinir bloğu ile multimodal analjezi uygulanan Grup M ve yalnızca standart sistemik analjezi alan Grup S. Veriler, anestezi ve postoperatif analjezi kayıtlarından elde edildi. Hastalar postoperatif üçüncü ayda telefonla aranarak ağrı durumları sorgulandı. CPSP, üçüncü ayın sonunda devam eden ağrı olarak tanımlandı. Yanma, karıncalanma, kaşıntı ve uyuşukluk gibi nöropatik özellikler ayrıca değerlendirildi. Bulgular: Toplam 191 hasta çalışmaya dahil edildi: Grup M’de 90, Grup S’de 101 hasta. Grupların demografik özellikleri karşılaştırılabilir düzeydeydi. Üçüncü ayda CPSP insidansı Grup M’de %27,8 ve Grup S’de %28,7 olarak bulundu (p = 0,886). Tüm ağrılar insizyon bölgesinde lokalizeydi ve çoğunlukla hafif ve aralıklıydı. Yanma ve karıncalanma açısından gruplar arasında fark saptanmadı. Ancak kaşıntı (Grup M’de %60, Grup S’de %89,7; p = 0,011) ve uyuşukluk (Grup M’de %36, Grup S’de %72,4; p = 0,007) blok uygulanan grupta anlamlı olarak daha düşük bulundu. Sonuç: Sezaryen sonrası üçüncü ayda CPSP insidansı, fasyal plan bloğu uygulanan hastalar ile standart analjezi alan hastalar arasında benzer bulundu. Bununla birlikte, fasyal plan blokları bazı nöropatik semptomların daha az görülmesi ile ilişkiliydi ve postoperatif ağrı yönetiminde niteliksel bir fayda sağlayabileceğini düşündürmektedir.

Keywords

• sezaryen
• kronik ağrı
• multimodal analjezi
• cerrahi sonrası kronik ağrı
• fasyal plan blokları

The efficacy of ultrasound-guided regional anesthesia on chronic postoperative pain in patients who underwent caesarean section: a retrospective study

Abstract

Aims: Chronic postsurgical pain (CPSP) is an well-recognised complication following caesarean delivery and may adversely affect maternal quality of life. Effective postoperative analgesia has been suggested to reduce the risk of CPSP. This study aimed to evaluate the effect of ultrasound-guided regional blocks, applied as part of multimodal analgesia, on the incidence and characteristics of CPSP after caesarean section under spinal anaesthesia. Methods: This retrospective, single-center cohort study included women aged 18–40 years with singleton pregnancies who underwent elective caesarean section under spinal anaesthesia between January 2024 and March 2025. Patients were divided into two groups: Group RA (regional anesthesia), who received multimodal analgesia with either anterior quadratus lumborum block or ilioinguinal–iliohypogastric nerve block, and group non-RA, who received standard systemic analgesia alone. Data were obtained from anaesthesia and postoperative analgesia records. Patients were contacted by telephone after completing ≥90 postoperative days to assess their pain status. Neuropathic features such as burning, tingling, itching, and numbness were also evaluated. Results: A total of 191 patients were included: 90 in group RA and 101 in group non-RA. The demographic characteristics of the two groups were comparable. The incidence of CPSP at three months was 27.8% in group RA and 28.7% in group non-RA (p=0.886). All pain was localised to the incision site and was mostly mild and intermittent. No significant differences were found between the groups for burning (8.9% in group non-RA vs. 8.9% in group RA), tingling (10.9% in group non-RA vs. 7.8% in group RA), and itching (25.7% in group non-RA vs. 16.7% in group RA). However, the rate of numbness was significantly higher in the non-RA group compared to the RA group (20.8% vs. 10.0%, p=0.041). Conclusion: The incidence of CPSP at ≥3 months after caesarean delivery was similar between patients receiving regional blocks and those treated with standard analgesia. However, regional blocks were associated with a lower frequency of certain neuropathic symptoms, suggesting a potential qualitative benefit in postoperative pain management.

Keywords

• Caesarean delivery
• multimodal analgesia
• chronic pain
• chronic postsurgical pain
• fascial plane blosks

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