Tiroidektomi Sonrası Baş-Boyun Germe Egzersizlerinin Ameliyat Sonrası Ağrı ve Rahatsızlık Düzeyine Etkisi

Yıl 2022, Cilt: 4 Sayı: 2, 177 - 186, 25.08.2022

Açelya Türkmen İkbal Çavdar Nihat Aksakal

Öz

Amaç: Tiroidektomi sonrası baş-boyun germe egzersizlerinin ameliyat sonrası boyun ağrısı ve rahatsızlık düzeyine etkisini belirlemek.
Yöntem: Bu randomize kontrollü çalışma, İstanbul'da bir üniversite hastanesinde Ocak 2019-Ağustos 2020 tarihleri arasında yapıldı. Örneklem, baş-boyun germe egzersizleri veya rutin bakım almak üzere randomize edilmiş 82 hastadan oluşuyordu. Müdahale grubuna ameliyat sonrası birinci gün araştırmacı ile eş zamanlı olarak baş-boyun egzersizleri uygulandı. Hastadan egzersizleri bir ay boyunca sabah, öğle ve akşam olmak üzere günde 3 kez yapması istendi. Kontrol grubunda ise aynı aralıklara sadece ölçekler uygulandı.
Bulgular: Çalışmaya katılan hastaların çoğu (%79.2) kadındı. %62.19'unun tanısı multinodüler guatrdı. %70,73'ü total tiroidektomi ameliyatı geçirmişti. Müdahale grubundaki hastaların postoperatif birinci gün Görsel Analog Skalası (GAS) ortalaması (2.20±2.22) kontrol grubuna göre (3.00±2.10) daha düşüktü. Ameliyattan 1 hafta ve 1 ay sonra boyunda rahatsızlık ve ağrı açısından müdahale ve kontrol grubundaki hastalar arasında anlamlı bir fark yoktu. Ancak birinci hafta ve birinci ayda boyun ağrısı ve rahatsızlıklarında gruplar arasında anlamlı fark gözlendi (p<0.05).
Sonuç: Baş-boyun germe egzersizinin hastalarda ameliyat sonrası boyun ağrısını ve rahatsızlığını azaltmada etkili bir hemşirelik girişimi olduğu bulundu. Baş-boyun germe egzersizi postoperatif hemşirelik bakımında farmakolojik olmayan bir tedavi yöntemi olarak kullanılabilir.

Anahtar Kelimeler

Tiroidektomi, Boyun Ağrısı, Boyun Germe Egzersizleri, Rahatsızlık

The Effect of Head-Neck Stretching Exercises After Thyroidectomy on Postoperative Level of Pain and Disability

Öz

Objective: To determine the effect of post-thyroidectomy head-neck stretching exercises on postoperative level of neck pain and disability.
Methods: This randomized controlled study was conducted between January 2019 and August 2020 in a university hospital in Istanbul. The sample consisted of 82 patients randomized to receive head-neck stretching exercises or routine care. The head-neck exercises were applied to the intervention group in synchronously with the researcher on the first postoperative day. The patient was asked to perform the exercises 3 times a day, in the morning, noon and evening for a month. Only scales were applied to the same ranges in the control group.
Results: Most of the patients (79.2%) participating in the study were women. The diagnosis of 62.19% was multinodular goiter. 70.73% of them had undergone total thyroidectomy surgery. The average of the Visual Analogue Scale (VAS) of patients in intervention group on first postoperative day was lower (2.20± 2.22) than in control group (3.00 ± 2.10). There was no significant difference between patients in intervention and control groups in discomfort and pain in the neck after 1 week and 1 month of surgery. However, a significant difference within the groups in neck pain and discomfort at first week and first month was observed (p <0.05).
Conclusions: It was found that the head-neck stretching exercise was an effective nursing intervention in reducing postoperative neck pain and disability in the patients. Head-neck stretching exercise can be used as a non pharmacological treatment method in postoperative nursing care.

Anahtar Kelimeler

Thyroidectomy, Neck Pain, Neck Stretching Exercise, Disability

Kaynakça

• Al Qubaisi, M., & Haigh, P. I. (2019). Hypocalcemia after Total Thyroidectomy in Graves Disease. The Permanente Journal, 23, 18-188. https://doi.org/10.7812/TPP/18-188
• Atasayar, S., & Guler Demir, S. (2019). Determination of the Problems Experienced by Patients Post-Thyroidectomy. Clinical Nursing Research, 28(5), 615–635. https://doi.org/10.1177/1054773817729074
• Ayhan, H., Tastan, S., Iyigün, E., Oztürk, E., Yildiz, R., & Görgülü, S. (2016). The Effectiveness of Neck Stretching Exercises Following Total Thyroidectomy on Reducing Neck Pain and Disability: A Randomized Controlled Trial. Worldviews on Evidence-Based Nursing, 13(3), 224–231. https://doi.org/10.1111/wvn.12136
• Barua, S. M., Mishra, A., Kishore, K., Mishra, S. K., Chand, G., Agarwal, G., Agarwal, A., & Verma, A. K. (2016). Effect of Preoperative Nerve Block on Postthyroidectomy Headache and Cervical Pain: A Randomized Prospective Study. Journal of Thyroid Research, 9785849. https://doi.org/10.1155/2016/9785849
• Bicer, A., Yazici, A., Camdeviren, H., & Erdogan, C. (2004). Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale. Disability and Rehabilitation, 26(16), 959–962. https://doi.org/10.1080/09638280410001696755
• Brown, R. L., de Souza, J. A., & Cohen, E. E. (2011). Thyroid cancer: burden of illness and management of disease. Journal of Cancer, 2, 193–199. https://doi.org/10.7150/jca.2.193
• Chai, Y. J., Song, J., Kang, J., Woo, J. W., Song, R. Y., Kwon, H., Kim, S. J., Choi, J. Y., & Lee, K. E. (2016). A comparative study of postoperative pain for open thyroidectomy versus bilateral axillo-breast approach robotic thyroidectomy using a self-reporting application for iPad. Annals of Surgical Treatment and Research, 90(5), 239–245. https://doi.org/10.4174/astr.2016.90.5.239
• Chung, Y. S., Choe, J. H., Kang, K. H., Kim, S. W., Chung, K. W., Park, K. S., Han, W., Noh, D. Y., Oh, S. K., & Youn, Y. K. (2007). Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World Journal of Surgery, 31(12), 2302–2308. https://doi.org/10.1007/s00268-007-9117-0
• Cağlayan, K., & Celik, A. Surgical methods and complications in benign thyroid disease: Thyroidectomy and its complications. (2010). Turkish Journal of Surgery / National Journal of Surgery, 26(3). https://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=0&sid=29084312-8913-4cc3-910c-86343d523fff%40sdc-v-sessmgr02
• Delbridge L. (2003). Total thyroidectomy: the evolution of surgical technique. ANZ Journal of Surgery, 73(9), 761–768. https://doi.org/10.1046/j.1445-2197.2003.02756.x
• Genç, A., Çelik, S. U., Genç, V., Gökmen, D., & Tur, B. S. (2019). The effects of cervical kinesiotaping on neck pain, range of motion, and disability in patients following thyroidectomy: a randomized, double-blind, sham-controlled clinical trial. Turkish Journal of Medical Sciences, 49(4), 1185–1191. https://doi.org/10.3906/sag-1812-55
• Han, D. W., Koo, B. N., Chung, W. Y., Park, C. S., Kim, S. Y., Palmer, P. P., & Kim, K. J. (2006). Preoperative greater occipital nerve block in total thyroidectomy patients can reduce postoperative occipital headache and posterior neck pain. Thyroid: official journal of the American Thyroid Association, 16(6), 599–603. https://doi.org/10.1089/thy.2006.16.599
• Ha, T. K., Kim, D. W., Park, H. K., Shin, G. W., Heo, Y. J., Baek, J. W., Lee, Y. J., Choo, H. J., Kim, D. H., Jung, S. J., Park, J. S., Moon, S. H., Ahn, K. J., Baek, H. J., & Kang, T. (2018). Comparison of Postoperative Neck Pain and Discomfort, Swallowing Difficulty, and Voice Change After Conventional Open, Endoscopic, and Robotic Thyroidectomy: A Single-Center Cohort Study. Frontiers in Endocrinology, 9, 416. https://doi.org/10.3389/fendo.2018.00416
• Hauch, A., Al-Qurayshi, Z., Randolph, G., & Kandil, E. (2014). Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Annals of Surgical Oncology, 21(12), 3844–3852. https://doi.org/10.1245/s10434-014-3846-8
• Jang, J. Y., Chang, Y. S., Kim, E. H., Moon, J. H., & Son, Y. I. (2014). Early neck exercises to reduce post-thyroidectomy syndrome after uncomplicated thyroid surgery: a prospective randomized study. Journal of Korean Thyroid Association, 7(1), 70-76. http://www.ijthyroid.org/journal/view.html?volume=7&number=1&spage=70
• Kalmovich, L. M., Cote, V., Sands, N., Black, M., Payne, R., & Hier, M. (2010). Thyroidectomy: exactly how painful is it?. Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 39(3), 277–283.
• Lang, B. H., Ng, S. H., & Wong, K. P. (2015). Pain and surgical outcomes with and without neck extension in standard open thyroidectomy: a prospective randomized trial. Head & Neck, 37(3), 407–412. https://doi.org/10.1002/hed.23611
• Li, N., Han, X., Lv, Z., & Wang, P. Clinical Observation and Nursing Experience of Complications in Thyroid Surgery. 2018, October. In 2018 9th International Conference on Information Technology in Medicine and Education (ITME) (pp. 95-97). IEEE. Hangzhou, China. https://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=8589263
• Miccoli, P., Rago, R., Massi, M., Panicucci, E., Metelli, M. R., Berti, P., & Minuto, M. N. (2010). Standard versus video-assisted thyroidectomy: objective postoperative pain evaluation. Surgical Endoscopy, 24(10), 2415–2417. https://doi.org/10.1007/s00464-010-0964-7
• Nakamura, K., Kodama, T., & Mukaino, Y. (2014). Effects of active individual muscle stretching on muscle function. Journal of Physical Therapy Science, 26(3), 341–344. https://doi.org/10.1589/jpts.26.341
• Park, C., Choi, J. B., Lee, Y. S., Chang, H. S., Shin, C. S., Kim, S., & Han, D. W. (2015). The effect of intra-operative transcutaneous electrical nerve stimulation on posterior neck pain following thyroidectomy. Anaesthesia, 70(4), 434–439. https://doi.org/10.1111/anae.12933
• Price, D. D., McGrath, P. A., Rafii, A., & Buckingham, B. (1983). The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain, 17(1), 45–56. https://doi.org/10.1016/0304-3959(83)90126-4
• Ryu, H. R., Lee, J., Park, J. H., Kang, S. W., Jeong, J. J., Hong, J. Y., & Chung, W. Y. (2013). A comparison of postoperative pain after conventional open thyroidectomy and transaxillary single-incision robotic thyroidectomy: a prospective study. Annals of Surgical Oncology, 20(7), 2279–2284. https://doi.org/10.1245/s10434-012-2557-2
• Rodríguez-Torres, J., López-López, L., Cabrera-Martos, I., Torres-Sánchez, I., Ortíz-Rubio, A., & Valenza, M. C. (2019). Musculoskeletal neck disorders in thyroid cancer patients after thyroidectomy. European Journal of Cancer Care, 28(4), e13053. https://doi.org/10.1111/ecc.13053
• Roerink, S. H., Coolen, L., Schenning, M. E., Husson, O., Smit, J. W., Marres, H. A., de Wilt, J. H., & Netea-Maier, R. T. (2017). High prevalence of self-reported shoulder complaints after thyroid carcinoma surgery. Head & Neck, 39(2), 260–268. https://doi.org/10.1002/hed.24579
• Sosa, J. A., & Udelsman, R. (2006). Total thyroidectomy for differentiated thyroid cancer. Journal of Surgical Oncology, 94(8), 701–707. https://doi.org/10.1002/jso.20695
• Spanheimer, P. M., Sugg, S. L., Lal, G., Howe, J. R., & Weigel, R. J. (2011). Surveillance and intervention after thyroid lobectomy. Annals of Surgical Oncology, 18(6), 1729–1733. https://doi.org/10.1245/s10434-010-1544-8
• Takamura, Y., Miyauchi, A., Tomoda, C., Uruno, T., Ito, Y., Miya, A., Kobayashi, K., Matsuzuka, F., Amino, N., & Kuma, K. (2005). Stretching exercises to reduce symptoms of postoperative neck discomfort after thyroid surgery: prospective randomized study. World Journal of Surgery, 29(6), 775–779. https://doi.org/10.1007/s00268-005-7722-3
• Wheeler, A. H., Goolkasian, P., Baird, A. C., & Darden, B. V. (1999). Development of the Neck Pain and Disability Scale. Item analysis, face, and criterion-related validity. Spine, 24(13), 1290–1294. https://doi.org/10.1097/00007632-199907010-00004
• Worni, M., Schudel, H. H., Seifert, E., Inglin, R., Hagemann, M., Vorburger, S. A., & Candinas, D. (2008). Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Annals of Surgery, 248(6), 1060–1066. https://doi.org/10.1097/SLA.0b013e31818c709a