YÜCEL KARAMAN, Hüseyin ÖZKARAKAŞ, SEMRA KARAMAN, Murat TURAN, Mustafa GÖNÜLLÜ, Meltem UYAR, Zeki TEKGÜL

İnguinal herni onarımı sonrası kronik ağrı insidansı

Amaç: İnguinal herni onarımı sonrası erişkinlerde %5-35 oranında kronik ağrı gelişmektedir. Bu ağrının; uygulanan cerrahi tekniğe, ameliyat öncesi ve sonrası ağrıya, hastanın psikososyal ve fzyolojik yapısına veya diğer nedenlere bağlı oluşabileceği belirtilmekle birlikte kesin bir fkir birliği bulunmamaktadır. Bu çalışmada; inguinal herni onarımı sonrası gelişen kronik ağrının görülme sıklığı ve risk faktörlerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: 2011 yılı Ocak ayı ile 2012 yılı Aralık ayı arasında inguinal herni onarımı yapılan 204 hasta çalışmaya dahil edildi. İlk 24 saat içindeki akut ağrıları VAS ile ölçülen hastaların operasyon sonrası üçüncü ve altıncı ay içerisindeki bulguları telefon görüşmesi ile kaydedildi. Ağrı veya başka bir rahatsızlığın varlığı, ağrı kesici ilaç kullanımı, VAS değerleri ve ağrının karakterine ilişkin bulgular araştırıldı. Operasyondan üç ay sonrasında VAS ≥3 olan hastalardaki ağrı, kronik ağrı olarak değerlendirildi. Bulgular: Operasyondan üç ay sonrasında devam eden ameliyat sonrası ağrı insidansı %18, altı ay sonra sonrasında ise %11.2 olarak bulundu. Hastaların %78.3ünde ameliyat öncesi ağrı olduğu ve %21.8inde kronik ağrı geliştiği saptandı. Ameliyat sonrası ilk 24 saatteki VAS değerlerinin ortalaması kronik ağrı gelişenlerde 3.13±1.12 ve kronik ağrı gelişmeyenlerde ise 1.71±1.27 olarak bulundu. Herni onarımı reoperasyonu olan hastaların (%5.2) hepsinde kronik ağrı geliştiği görüldü. Has- taların %48inde kronik ağrı nöropatik özellikler taşıyordu ve şiddeti orta düzeyde idi. Sonuç: İnguinal herni onarımı sonrası %18 olarak bulduğumuz ameliyat sonrası kronik ağrı oranı yapılan benzer çalışmalar ile uyumludur. Diğer risk faktörleri ile karşılaştırıldığında; ameliyat öncesi dönemde ağrının varlığı, ameliyat sonrası akut ağrının şiddeti ve reoperasyonlar ameliyat sonrası kronik ağrının gelişiminde en önemli risk faktörleri olarak değerlendirildi.

Incidence of chronic pain after ingunial hernia repair

Objectives: Te percentage of chronic pain in adults having inguinal hernia repair is 5-35%. Although this pain is thought to be related to some reasons, there is not an exact conclusion about this. In this study, the aim was to point out the incidence of chronic pain after inguinal hernia repair and determination of the risk factors. Methods: Two hundred and four patients having inguinal hernia surgery between January 2011 and December 2012 were included into this study. Te patients pain was measured with VAS within 24 hours and at the third and the sixth month after surgery. Te patients whose VAS was>3 three months after surgery were evaluated to have chronic pain. Results: Te incidence of pain continuing 3 months after surgery was 18.6% and 11.2% six months after surgery. 78.3% of the pa- tients had already had pain before surgery, and in 28% of them, chronic pain had evolved. Te measure of VAS within 24 hours post- operatively was found higher in patients who developed chronic pain (3.13±1.12/1.71±1.27). 5.2% of the patients had re-operation for reparation and chronic pain developed in all. Chronic pain was neuropathic in 48% of the patients, and its severity was moderate. Conclusion: Te incidence of chronic pain after inguinal hernia repair was found %18, compatible with similar studies. Compared with other risk factors, preoperative pain, postoperative severe acute pain and reoperations were thought to be the most important risk factors for the development of chronic pain.

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