Künt Toraks Travması Sonrası Gelişen Multipl Kot Fraktürlerinde Ağrı Kontrolü İçin TENS (Transkutanöz Elektriksel Sinir Stimülasyonu)

Yıl 2023, Cilt: 10 Sayı: 1, 51 - 57, 10.04.2023

Huriye Gülistan Bozdağ Başkaya , Ufuk Çağırıcı

https://doi.org/10.47572/muskutd.1113215

Cited By: 1

Öz

Kot fraktürlerinde ağrının giderilmesi tedavinin temelini oluşturur. Bu çalışmayla, multipl kot fraktürü gelişen olgularda ağrı kontrolü için TENS etkinliği araştırıldı. Ege Üniversitesi Tıp Fakültesi Göğüs Cerrahisi Anabilim Dalı’nda, Eylül 2013-Ağustos 2014 tarihleri arasında, künt toraks travması nedeniyle multipl kot fraktürü bulunan, herhangi bir cerrahi girişim uygulanmamış 40 olgu çalışmaya dahil edildi. Hastalar TENS±analjezik ilaç uygulanan grup (Grup 1) ile sadece analjezik ilaç uygulanan grup (Grup 2) olmak üzere 2 gruba randomize edildi. Her iki grubun 0., 2., 6., 12., 24., 48. ve 72. saatlerdeki ağrı düzeyi vizüel analog skala (VAS) ile değerlendirildi. Grup 1’e 0. saatteki VAS>4 olanlara bir saat boyunca TENS uygulandı. Takip eden günlerde VAS>4 ise günde bir kez bir saat boyunca işlem tekrarlandı. İşleme rağmen VAS>4 olarak sürdüğünde tedaviye öncelikle non-steroid anti-inflamatuar ilaç (NSAİİ), gereğinde parasetamol eklendi. İkinci grupta 0. saat VAS≥4 olanlara sadece NSAİİ, gereğinde parasetamol verildi. Hastaların 0., 2., 6., 12., 24., 48. ve 72. saat VAS değerleri karşılaştırıldı. Her iki grupta da VAS değerlerinde azalma oldu, bu fark istatistiksel olarak anlamlı idi (p<0.05). Geliş VAS değeri (VAS_0) saatlere göre analiz edildiğinde ise, 24. saat hariç olmak üzere (p=0.933) tüm ölçüm yapılan saatlerde Grup 1 ile Grup 2 arasındaki fark istatistiksel olarak anlamlı bulundu (p<0.001). Grup 1’de NSAİİ kullanımının 24. saat hariç (p=0.287), diğer günlerde ve toplamda anlamlı derecede azaldığı görüldü (sırasıyla, p=0.001 ve p<0.001). Yan etkisi az ve kolay uygulanabilir bir yöntem olan TENS, multipl kot fraktürlerinde ağrıyı gidermede etkilidir. TENS ile NSAİİ analjezik ihtiyacı azalmaktadır. TENS’in etkisi 24. saatte azaldığından daha sık aralıklarla uygulanması önerilebilir.

Anahtar Kelimeler

Göğüs Ağrısı, Kot Fraktürleri, TENS

Destekleyen Kurum

yok

TENS (Transcutaneous Electrical Nerve Stimulation) for Pain Control in Multiple Rib Fractures After Blunt Thoracic Trauma

Öz

Relief of pain in rib fractures is the basis of treatment. In this study, the effectiveness of TENS for pain control in patients with multiple rib fractures was investigated. Forty patients with multiple rib fractures due to blunt thoracic trauma, who did not undergo any surgical intervention, between September 2013 and August 2014 at Ege University Faculty of Medicine, Department of Thoracic Surgery were included in the study. The patients were randomized into 2 groups: TENS±analgesic drug administered group (Group 1) and analgesic drug-only group (Group 2). Pain level of both groups at 0, 2, 6, 12, 24, 48 and 72. hours was evaluated with visual analog scale (VAS). In group 1, TENS was applied for 1 hour to those with VAS>4 at hour 0. In the following days, if the VAS was>4, the procedure was repeated once a day for 1 hour. Non-steroidal anti-inflamatory drug (NSAID) and paracetamol as needed were added to the treatment when the VAS persisted as >4 despite the procedure. In the second group, only NSAID and paracetamol as needed were given with VAS≥4 at hour 0. The 0, 2, 6, 12, 24, 48 and 72. hours VAS values of the patients were compared. There was a decrease in VAS values in both groups, this difference was statistically significant (p<0.05). When 0.th hour VAS value was analyzed according to hours, the difference between Group 1 and Group 2 was statistically significant (p<0.001) at all hours of measurement, except for the 24th hour (p=0.933). It was observed that NSAID use decreased significantly in Group 1, except for the 24th hour (p=0.287), on other days and in total (p=0.001 and p<0.001, respectively). TENS, which has few side effects and is an easily applicable method, is effective in relieving pain in multiple rib fractures. With TENS, the need for NSAID analgesics is reduced. Since the effect of TENS decreases at the 24th hour, it may be recommended to apply it at more frequent intervals.

Anahtar Kelimeler

Chest Pain, Rib Fractures, TENS

Kaynakça

• 1. Eren N, Balcı E. Toraks travmaları. In: Ökten İ, Güngör A (eds). Göğüs Cerrahisi. Cilt 1,1. Baskı. İstanbul: Sim Matbaacılık. 2003;661-8.
• 2. Özçelik C, Alar T. Künt toraks travmaları. In: Ökten İ, Kavukçu Ş (eds). Göğüs Cerrahisi. Cilt 1, 2. Baskı. İstanbul: İstanbul Tıp Kitapevi. 2013;837-9.
• 3. Öncel M, Sencan S, Yıldız H, et al. Transcutaneous electrical nerve stimulation for pain management in patients with uncomplicated minor rib fractures. Eur J Cardiothorac Surg. 2002;22:13-7.
• 4. Johnson M. Transcutaneous electrical nerve stimulation (TENS). In: Kitchen S ed. Electrotherapy: evidence-based practice. Edinburg: Churchill Livingstone. 2001;259-86.
• 5. Yalçınkaya İ, Kaya S, Taştepe İ, et al. Toraks travmalarında cerrahi yaklaşım. Ulus Travma Derg. 1995;1(1):27-30.
• 6. Çağırıcı U, Uç H, Çalkavur T, et al. Toraks travmaları: 6 yıllık deneyimlerimiz. Ulus Travma Derg. 1998;4:248-52.
• 7. Yazkan R, Özpolat B. Göğüs travmaları: 132 Olgunun değerlendirilmesi. Bidder Tıp Bilimleri Derg. 2010;2:15-20.
• 8. Berry PH, Chapman RC, Covington EC, et al. Pain: Current understanding of assessment management and treatments. NPC and JCAHO. 2001;1-100.
• 9. Blackall GF. Physical methods of pain management. In: Raj PP (ed). Practical management of pain, 3rd ed. St Louis: Mosby Inc. 2000. pp. 523-43.
• 10. Aydınlı I. Ağrının fizyopatolojisi, Türk Fiz Tıp Rehab Derg. 2005;51(Ek B):B8-13.
• 11. Solak Ö. Nöropatik ağrı tedavisi. Romatizma. 2008;23:135-42.
• 12. Jones I, Johnson M. Transcutaneous electrical nerve stimulation, continuing education in anesthesia. Crit Care Pain Med. 2009;9(4):130-5.
• 13. Kaye V, Brandstater ME. Transcutaneous electrical nerve stimulation. Emedicine. 2010;4(13):1-8.
• 14. Erçalık C. Fibromiyalji sendromunda bilişsel davranış tedavisi ve TENS Tedavilerinin Etkinliği, Uzmanlık Tezi, Şişli Etfal Eğitim ve Araştırma Hastanesi FTR Kliniği, İstanbul 2005.
• 15. Raphael J, Hester J, Ahmedzai S, et al. Palliative care section. Pain Med. 2010;11:872-96.
• 16. Tomanovic Vujadinovic S, Ilic N, Selakovic I, et al. TENS improves cisplatin-induced neuropathy in lung cancer patients. Medicina (Kaunas). 2022;58(10):1405.
• 17. Carroll D, Tramer M, McQuay H, et al. Randomization is important in studies with pain outcomes: systematic review of tens in acute postoperative pain. Br J Anaesth. 1996;71:798-803.
• 18. Wang B, Tang J, White PF, et al. Effect of the intensity of transcutaneous acupoint electrical stimulation on the postoperative analgesic requirement. Anesth Analg. 1997;85:406-13.
• 19. Rakel B, Frantz R. Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain with movement. J Pain. 2003;4(8):455-64.
• 20. Cuschieri RJ, Morran CG, McArdle CS. Transcutaneous electrical nerve stimulation for postoperative pain. Ann R Coll Surg Engl. 1985;Vol.67:127-9.
• 21. Yeğin A, Erdoğan A, Hadimioğlu N. Toraks cerrahisinde ameliyat sonrası analjezi, Turkish J Thorac Cardiovasc Surg. 2005;13(4):418-25.
• 22. Benedetti F, Amanzio M, Casadio C, et al. Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac Surg. 1997;63:773-6.
• 23. Brodsky JB, Mark JBD, Postthoracoscopy pain: Is TENS the answer? Ann Thorac Surg. 1997;63:608-10.
• 24. Forster EL, Kramer JF, Lucy SD, et al. Effect of transcutaneous electrical nerve stimulation on pain, medications and pulmonary function following coronary artery bypass graft surgery. Chest. 1994;106:1343-8.
• 25. Cipriano Jr G, Carvalhoet ACC, Bernardelli GF, et al. Short-term transcutaneous electrical nerve stimulation after cardiac surgery: effect on pain, pulmonary function and electrical muscle activity. Interact Cardiovasc Thorac Surg. 2008;7:539-43.
• 26. Emmiler M, Solak O, Kocogullari C, et al. Control of acute postoperative pain by transcutaneous electrical nerve stimulation after open cardiac operations: a randomized placebo-controlled prospective study. The Heart Surg. 2008;11(5):300-3.
• 27. Tunç M, Günal H, Bilgili T, et al. Torakotomi sonrası ağrı tedavisinde hasta kontrollü epidural analjezi yoluyla tramadol kullanımına TENS’in etkisi. Türk Anest Cem Mecmuası. 2002;30:315-21.
• 28. Chandra A, Banavaliker JN, Das PK, et al. Use of transcutaneous electrical nerve stimulation as a adjunctive to epidural analgesia in the management of acute thoracotomy pain. Indian J Anaesth. 2010;54:116-20.
• 29. Ferreira FC, Issy AM, Sakata RK. Assessing the efects of transcutaneous electrical nerve stimulation (TENS) in post-thoracotomy analgesia. Braz J Anesthesiol. 2011;61(5):561-7.
• 30. Erdoğan M, Erdoğan A, Erbil N, et al. A prospective randomized placebo-controlled study of the effect of transcutaneous electrical nerve stimulation on postthoracotomy pain and pulmonary function. World J Surg. 2005;29:1253-70.
• 31. Johnson MI, Paley CA, Jones G, et al. Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: A systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open. 2022;12(2);051073.
• 32. Johnson MI, Paley CA, Wittkopf PG, et al. Characterising the features of 381 clinical studies evaluating transcutaneous electrical nerve stimulation (TENS) for pain relief: a secondary analysis of the meta-TENS study to improve future research. Medicina. 2022;58(6):803.
• 33. Vance CGT, Dailey DL, Chimenti RL, et al. Using TENS for pain control: update on the state of the evidence. Medicina (Kaunas). 2022;58(10):1332.