SPİNAL ANESTEZİNİN KOMPLİKASYONLARINDAN BİRİ: SPİNAL CERRAHİ SONRASI BEL AĞRISI VE PREEMPTİF TOPİKAL DİKLOFENAK KULLANIMI

Year 2022, Volume: 1 Issue: 1, 1 - 7, 01.03.2022

Erkan Cem Çelik Mürsel Ekinci Eyüp Şenocak Birzat Emre Gölboyu Osman Özgür Kılınç

Abstract

Giriş: Pre-emptive analjezik ilaçlar post-operatif ve anestetik müdahale ağrısının yönetiminde önemlidir. Bu
çalışmada, diklofenak dietilamonyumun spinal anesteziden sonra sırt ağrısının önlenmesinde topik uygulanmasının etkisini
araştırmak amaçlandı. Metod: Bu randomize kontrollü klinik çalışma, elektif cerrahi girişim planlanan 18-70 yaş arasındaki
210 diz artroskopi hastasından oluşmaktadır. Hastalar rasgele seçilerek bir kısmı diklofenak dietilamonyum grubuna (Grup D)
bir kısmı plasebo grubu (Grup P) olarak tayin edildi. Spinal anestezi uygulanmadan önce, Grup D için topikal diklofenak
dietilamonyum jel, Grup P için topikal placebo jel, spinal anestezik uygulanacak lumbar bölgede cilt üzerine sürüldü. Bromage
motor skalası (BMS) 3 olduğunda, tüm hastalara addüktor kanal kateteri takıldı. Visual Analog Skala (VAS) kullanılarak
hastalara spinal anestezi uygulanan alanda bulunan ağrı sorgulandı. 1, 2, 4, 8, 16 and 24. saatlerde cerrahi sonrası hastaların
VAS skorları not edildi. Bulgular: Grupların demografik verileri, spinal anestezi ile ilgili bazı veriler, operasyon süresi ve
perioperatif analjezi oranları arasında istatistiksel olarak fark yoktu. Ancak, grupların postoperatif analjezi kullanımları
arasında istatistiksel olarak anlamlı farklılık vardı. Operasyondan sonra 1, 2, 4, 8, 16 ve 24 saatlerde, bir hafta ve altı ay sonra
tüm grupların VAS değerlerine bakıldığında, istirahat ve hareket halinde Grup D’nin VAS değerlerinin daha düşük olduğu
görülmüştür ve her iki grup arasında istatistiksel olarak anlamlı fark vardır. Sonuç: Spinal anesteziden sonra topikal diklofenak
kullanılması sırt ağrısı sıklığını azaltabilir.

Keywords

Preemptif analjezi, Topikal analjezi, post spinal baş ağrısı, Nonsteroid inflamatuar ilaçlar.

ONE OF THE COMPLICATIONS OF SPINAL ANESTHESIA: POSTSPINAL BACK-ACHE AND PREEMPTIVE USAGE OF THE TOPICAL DICLOFENAC

Abstract

interventions' pain. Present study was to examine the effect of the topical application of diclofenac diethylammonium on the
prevention of backache after spinal anaesthesia. Methods: This randomized, controlled clinical study consisted of 210 knee
arthroscopy patients aged 18–70 years who were scheduled to undergo elective surgery. The patients were randomly assigned
to a diclofenac diethylammonium group (Group D) or a placebo group (Group P). Before administration of spinal anaesthesia,
diclofenac diethylammonium gel for Group D, plasebo gel for Group P was rubbed onto the skin in the lumbar region where
the spinal anaesthetic was to be applied. When the Bromage motor scale (BMS) was 3, an adductor canal catheter was inserted.
Using the Visual Analog Scale (VAS), the patients were asked about pain in the area where the spinal anaesthetic had been
administered. VAS values were recorded 1, 2, 4, 8, 16 and 24 h after the surgery. Results: There wasn’t statistically difference
between the groups’ demographic datas, some datas about spinal anesthesia, duration of the operation and ratios of perioperative
analgesia. But there was a statistically differences between the groups’ postoperative analgesia. When the groups’ 1, 2, 4, 8, 16
and 24-h VAS values and VAS values one week and six months after the surgery were evaluated, there was a statistically
significant difference between the two groups in rest and dynamic. Conclusion: The use of topical diclofenac after spinal
anaesthesia can significantly reduce the incidence of backache.

Keywords

Analgesia, Anesthesia, Spinal, Backache, NSAIDs, Nerve block

References

• Referans 1. Tekgul ZT, Pektas S, Turan M, Karaman Y, Cakmak M, Gonullu M. Acute Back Pain Following Surgery under Spinal Anesthesia. Pain practice : the official journal of World Institute of Pain. 2015;15(8):706-11.
• Referans 2. Lowery S, Oliver A. Incidence of postdural puncture headache and backache following diagnostic/therapeutic lumbar puncture using a 22G cutting spinal needle, and after introduction of a 25G pencil point spinal needle. Paediatric anaesthesia. 2008;18(3):230-4.
• Referans 3. Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. British journal of anaesthesia. 2002;89(3):409-23.
• Referans 4. Kılıç E, Mızrak A, Göksu S, Cesur M. Fonksiyonel endoskopik sinüs cerrahisinde gabapentin ve nimesulidin preemptif analjezik etkinliği. AĞRI 2014;26(2):73-81.
• Referans 5. Schwabe K, Hopf HB. Persistent back pain after spinal anaesthesia in the non-obstetric setting: incidence and predisposing factors. British journal of anaesthesia. 2001;86(4):535-9.
• Referans 6. Brattebo G, Wisborg T, Rodt SA, Roste I. Is the pencil point spinal needle a better choice in younger patients? A comparison of 24G Sprotte with 27G Quincke needles in an unselected group of general surgical patients below 46 years of age. Acta anaesthesiologica Scandinavica. 1995;39(4):535-8.
• Referans 7. Schultz AM, Ulbing S, Kaider A, Lehofer F. Postdural puncture headache and back pain after spinal anesthesia with 27-gauge Quincke and 26-gauge Atraucan needles. Regional anesthesia. 1996;21(5):461-4.
• Referans 8. Bajaj P, Ballary CC, Dongre NA, Baliga VP, Desai AA. Comparison of the effects of parecoxib and diclofenac in preemptive analgesia: A prospective, randomized, assessor-blind, single-dose, parallel-group study in patients undergoing elective general surgery. Current therapeutic research, clinical and experimental. 2004;65(5):383-97.
• Referans 9. Tolska HK, Takala A, Blomgren K, Hamunen K, Kontinen V. Topical Ropivacaine in Prevention of Post-Tonsillectomy Pain in Adults. Anesthesia and analgesia. 2017;124(5):1459-66.
• Referans 10. Whitlow PG, Saboda K, Roe DJ, Bazzell S, Wilson C. Topical analgesia treats pain and decreases propofol use during lumbar punctures in a randomized pediatric leukemia trial. Pediatric blood & cancer. 2015;62(1):85-90.
• Referans 11. Nair B, Taylor-Gjevre R. A Review of Topical Diclofenac Use in Musculoskeletal Disease. Pharmaceuticals (Basel, Switzerland). 2010;3(6):1892-908.
• Referans 12. Dureja GP, Iyer RN, Das G, Ahdal J, Narang P. Evidence and consensus recommendations for the pharmacological management of pain in India. Journal of pain research. 2017;10:709-36.
• Referans 13. Quaynor H, Corbey M, Berg P. Spinal anaesthesia in day-care surgery with a 26-gauge needle. British journal of anaesthesia. 1990;65(6):766-9.
• Referans 14. Nakamura S, Matsuura N, Ichinohe T. A new method of topical anesthesia by using anesthetic solution in a patch. Journal of endodontics. 2013;39(11):1369-73.
• Referans 15. Keating SC, Thomas AA, Flecknell PA, Leach MC. Evaluation of EMLA cream for preventing pain during tattooing of rabbits: changes in physiological, behavioural and facial expression responses. PloS one. 2012;7(9):e44437.
• Referans 16. Arnau B, Jovell E, Romero M, Gonzalez M, Esteba L, Garcia A. Lidocaine-prilocaine cream as analgesia for hysterosalpingography: a randomized, double blinded, controlled study. European journal of obstetrics, gynecology, and reproductive biology. 2014;182:216-9.
• Referans 17. Hong JP, Nam SM, Im CY, Yoon S, Kim TI, Kim EK, et al. Comparison of analgesic effect of preoperative topical diclofenac and ketorolac on postoperative pain after photorefractive keratectomy. Journal of cataract and refractive surgery. 2014;40(10):1689-96.
• Referans 18. Mohammadpour M, Jabbarvand M, Nikdel M, Adelpour M, Karimi N. Effect of preemptive topical diclofenac on postoperative pain relief after photorefractive keratectomy. Journal of cataract and refractive surgery. 2011;37(4):633-7.
• Referans 19. Salgado Filho MF, Goncalves HB, Pimentel Filho LH, Rodrigues Dda S, da Silva IP, Avarese de Figueiredo A, et al. Assessment of pain and hemodynamic response in older children undergoing circumcision: comparison of eutectic lidocaine/prilocaine cream and dorsal penile nerve block. Journal of pediatric urology. 2013;9(5):638-42.
• Referans 20. Pasqualucci A, de Angelis V, Contardo R, Colo F, Terrosu G, Donini A, et al. Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy. A randomized, double-blind, placebo-controlled study. Anesthesiology. 1996;85(1):11-20.
• Referans 21. David JM, Duarte Vogel S, Longo K, Sanchez D, Lawson G. The use of eutectic mixture of lidocaine and prilocaine in mice (Mus musculus) for tail vein injections. Veterinary anaesthesia and analgesia. 2014;41(6):654-9.
• Referans 22. Isiordia-Espinoza MA, Pozos-Guillen AJ, Martinez-Rider R, Herrera-Abarca JE, Perez-Urizar J. Preemptive analgesic effectiveness of oral ketorolac plus local tramadol after impacted mandibular third molar surgery. Medicina oral, patologia oral y cirugia bucal. 2011;16(6):e776-80.
• Referans 23. Kati I, Tekin M, Silay E, Huseyinoglu UA, Yildiz H. Does benzydamine hydrochloride applied preemptively reduce sore throat due to laryngeal mask airway? Anesthesia and analgesia. 2004;99(3):710-2, table of contents.
• Referans 24. Hancock MJ, Maher CG, Latimer J, McLachlan AJ, Cooper CW, Day RO, et al. Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial. Lancet (London, England). 2007;370(9599):1638-43.
• Referans 25. Derry S, Moore RA, Gaskell H, McIntyre M, Wiffen PJ. Topical NSAIDs for acute musculoskeletal pain in adults. The Cochrane database of systematic reviews. 2015(6):Cd007402.