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

Yıl 2019, Cilt: 16 Sayı: 1, 70 - 76, 22.03.2019

Turgay Altınbilek Sadiye Murat

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

Öz

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.

Anahtar Kelimeler

Fibromyalgia, lidocaine, scar

Kaynakça

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