TORAKAL DORSAL KÖK GANGLİYONU PULSED RADYOFREKANS UYGULAMASININ ETKİNLİĞİNİN POSTHERPETİK NEVRALJİ İLE POSTTORAKOTOMİ AĞRI SENDROMLARI ÜZERİNE ETKİLERİNİN KARŞILAŞTIRILMASI

Öz

GİRİŞ: Herpes zoster (HZ), dorsal root ganglion ve periferik sinirin inflamasyonuna ve desendan duyu siniri boyunca lokal doku yaralanmasına neden olan reaktive varisella-zoster virüsünden kaynaklanır. HZ, uzun süreli ağrı, yani postherpetik nevralji (PHN) ile komplike olabilen şiddetli ve ağrılı döküntülere neden olur. Post-torakotomi ağrı sendromu (PTPS), International Association for the Study of Pain (IASP) tarafından “cerrahi işlemden en az iki ay sonra torakotomi insizyonu boyunca tekrarlayan veya devam eden ağrı” olarak tanımlanmaktadır⁸. GEREÇ ve YÖNTEM: Hastaların medikal kayıtları Algoloji bilim dalı arşivindeki hasta dosyalarından yaş, cinsiyet, taraf, torakal seviye, ağrı nedeni, VAS ve DN4 skorları taranmıştır. Floroskopi eşliğinde girişim yapıldıktan sonra her biri 2 dakikalık 2 döngü PRF verilip, PRF her 500 ms'de 20 ms pulsed uygulandı. İşlem sonrasında her bir uygulama DRG seviyesinde RF kanülden 4 mg deksametazon, 20 mg lidokain, 5 mg bupivakain ve toplam 5 ml olacak şekilde izotonik solüsyonu eklendi. SONUÇ: Çalışmaya 25 erkek (%62,5), 15 kadın (%37,5) olmak üzere, toplam 40 hasta dahil edildi. Hastaların ortalama yaşı 60.5±12.4 yıl, ortanca ağrı süreleri 2 yıldı (0.2-15 yıl) . Ağrı etyolojisine göre postherpetik nevralji ve post-torakotomi ağrı sendromu grubu kıyaslandığında tedavi öncesi VAS değerleri istatistik olarak farklı değilken (p=0.129), tedavi sonrasında post-torakotomi ağrı sendromu grubunun VAS sonucunun istatistik anlamlı olarak daha düşük olduğu saptandı(p=0.001). TARTIŞMA: Çalışmamızda DRG PRF tedavisinin kronik torasik ağrı nedenleri üzerine etkinliğini ve farklı etyolojilerde etki düzeyini araştırmayı amaçladık ve Pulsed RF tedavisinin Posttorakotomi hastalarında Postherpetik nevraljiye göre daha etkin bir tedavi olduğu sonucuna ulaştık. Ayrıca yaş, cinsiyet, taraf gibi faktörlerin tedaviye anlamlı bir etkisi olmadığını gördük.

Anahtar Kelimeler

• Postherpetik nevralji
• posttorakotomi ağrı sendromu
• pulsed radyofrekans
• torakal dorsal kök gangliyonu

Investigation of the Effects of Pulsed Radiofrequency Application of the Thoracal Dorsal Root Ganglion on Postherpetic Neuralgia and Post-thoracotomy Pain Syndromes

Abstract

Aim: The causative agent of herpes zoster (HZ) is the reactivated varicella-zoster virus. HZ leads to severe and painful rashes that can be accompanied by long-term pain, i.e., postherpetic neuralgia (PHN). According to the International Association for the Study of Pain (IASP), post-thoracotomy pain syndrome (PTPS) is defined as “recurrent or persistent pain along the thoracotomy incision at least two months after surgery”⁸. Methods: In this study, the medical records of all the patients were reviewed for age, gender, size, thoracic level, cause of pain, and visual analog scale (VAS) and DN4 scores from the patient files maintained in the archive of the Department of Algology. Two cycles of pulse radiofrequency (PRF) were administered for 2 min each. Then, a total of 5 ml of dexamethasone, lidocaine, bupivacaine, and isotonic solutions of 4 mg, 20 mg, 5 mg, and 5 mg, respectively, were added through the RF cannula at the DRG level in each application. Results: In total, 40 patients, including 25 men (62.5%) and 15 women (37.5%), were analyzed in this study. The mean age of the patients was 60.5 ± 12.4 years, and the median duration of pain was 2 years (0.2–15 years). When PHN and PTPS groups were compared on the basis of the pain etiology, the VAS values before treatment were not statistically different (p = 0.129), whereas the VAS values after treatment were significantly lower in the PTPS group than in the PHN group (p = 0.001). Conclusions: This study aimed to investigate the effectiveness of DRG PRF therapy on the causes of chronic thoracic pain and in different etiologies. The results revealed that PRF therapy is more effective in treating patients with PTPS than those with PHN. We also found that factors such as age, gender, and size did not significantly affect the treatment. Keywords: Postherpetic neuralgia, post-thoracotomy pain syndrome, pulsed radiofrequency

Keywords

• Postherpetic neuralgia
• post-thoracotomy pain syndrome
• pulsed radiofrequency

Kaynakça

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