İnguinal Herniyorafi ile İlişkili Cerrahi Sonrası Kronik Ağrının Yönetimi: Genel Cerrahların Anlayışları, Tutumları ve Deneyimleri

Öz

Amaç: İnguinal herniorafi dünya çapında yaygın bir cerrahi işlemdir. İnguinal herniyorafi ile ilişkili cerrahi sonrası kronik ağrı (GHCPSP), yaşam kalitesi üzerinde olumsuz bir etkiye sahiptir. Bu çalışmada, genel cerrahların GHCPSP ile ilgili bilgilerinin, tutumlarının ve deneyimlerinin değerlendirilmesi amaçlandı. Yöntemler: GHCPSP ile ilgili bir anket iki deneyimli genel cerrah ve bir ağrı doktoru tarafından tasarlandı ve deneyimli bir fıtık cerrahı tarafından gözden geçirildi. Anket, yanıtlayanların demografik özelliklerini değerlendirmek için dört soru; GHCPSP'nin ağrı özelliklerinin anlaşılması ve GHCPSP için ağrı tedavilerinin etkinliği ile ilgili dört soru; erken postoperatif ağrı ve GHCPSP yönetimine yönelik tutumlar hakkında beş soru; kasık fıtığı için cerrahi tekniklerin deneyimi ile GHCPSP'nin multidisipliner yönetimi için ağrı ve psikiyatri kliniklerine konsültasyon/işbirliği hakkında beş soru içeriyordu. Anket, Türk Cerrahi Derneği'nin tüm üyelerine e-posta ile gönderildi. Bulgular: Çalışma 259 katılımcıyı içeriyordu. Katılımcıların çoğunluğu (%248/95.8) erken postoperatif ağrı kontrolü için opiod olmayan ilaçlar reçete ettiğini, %20'si GHCPSP'yi değerlendirmek için doğrulanmış bir ölçek veya anket kullanıldığını belirtti. GHCPSP tedavisinde ankete katılanların %42'si parasetamol ve/veya NSAID'leri ve %42.9'u multimodal ajanları tercih ettiğini belirtti. Genel cerrahların belirttiğine göre, GHCPSP’li hastaları ağrı ve psikiyatri kliniklerine yönlendirme oranları ortalaması sırasıyla %30 ve %1 idi. Sonuçlar: Genel cerrahlar, erken dönemde herniorafi ile ilişkili ağrı hakkında yeterli bilgiye sahip iken GHCPSP'yi değerlendirme ve yönetme konusunda daha fazlasına ihtiyaçları vardır. Genel cerrahların, GHCPSP'ye multidisipliner yaklaşım konusunda bilgilendirilme ihtiyaçları vardır.

Anahtar Kelimeler

• inguinal herniorafi
• cerrahi sonrası kronik ağrı
• nöropatik ağrı
• multidisipliner yönetim
• algoloji

Management of Groin Herniorrhaphy-Related Chronic Postsurgical Pain: General Surgeons’ Understanding, Attitudes, and Experiences

Öz

Aim: Groin herniorrhaphy is a common surgical procedure worldwide. Groin herniorrhaphy-related chronic postsurgical pain (GHCPSP) has a negative effect on quality of life. This survey evaluated general surgeons’ knowledge, attitudes, and experiences with GHCPSP. Methods: A survey on GHCPSP was designed by two experienced general surgeons and a pain physician and reviewed by an experienced hernia surgeon. The survey included four questions to assess demographic characteristics of the respondents; four questions related to understanding of pain characteristics of GHCPSP and the effectiveness of pain treatments for GHCPSP; five questions about attitudes towards management of early postoperative pain and GHCPSP; five questions related to experience of surgical techniques for groin herniorrhaphy, consultation rates to pain and psychiatry clinics for multidisciplinary management of GHCPSP, and working collaboration with a pain clinic. The survey was emailed to all members of the Turkish Surgical Society. Results: The study included 259 respondents. The majority (248/95.8%) of respondents prescribed non-opiod medications for early postoperative pain control. A validated scale or questionnaire was used to assess GHCPSP by 20% of the respondents. 42% of the respondents favored paracetamol and/or NSAIDs for GHCPSP, and 42.9% favored multimodal agents for GHCPSP. The average consultation rates of respondents to pain and psychiatry clinics for GHCPSP was 30% and 1%, respectively. Conclusions: General surgeons have sufficient understanding of early herniorrhaphy-related pain but poor understanding of evaluating pain severity in CPSP and its management, suggesting a multidisciplinary approach to GHCPSP should be promulgated to general surgeons.

Anahtar Kelimeler

• herniorrhaphy
• chronic postsurgical pain
• neuropathic pain
• multidisciplinary management
• pain medicine

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