Miyofasiyal ağrıda ultrason eşliğinde yapılan trapezius kası interfasiyal bloku sonuçlarımız

Amaç: Miyofasiyal ağrı sendromu, kas iskelet sisteminde hiperirritabıl noktalardan kaynaklanan ağrıya neden olan bölgesel bir ağrı sendromudur. Miyofasiyal ağrı sendromu kronik ağrının en sık sebebidir ve trapezius kası en sık etkilenen kaslardan biridir. Bu çalışmada, trapezius kasındaki tetik noktaya bağlı miyofasiyal ağrı sendromu olan hastalara uyguladığımız ultrason eşliğinde trapezius kası interfasiyal blokunun etkinliğinin geriye dönük olarak değerlendirilmesi amaçlandı. Gereç ve Yöntem: Bu çalışmada, retrospektif olarak algoloji polikliniğinde Kasım 2019-Ekim 2020 tarihleri arasında miyofasiyal ağrı nedeniyle ultrason eşliğinde trapezius kası interfasiyal bloku uygulanan hastaların dosyaları incelendi. Hastaların işlem öncesi ve işlem sonrası ağrı düzeyleri Numerik Rating Skala ile değerlendirildi. İşlemden sonra ağrıda %50 ve daha fazla oranda azalma olan hastaların işlemden faydalandığı kabul edildi. Bulgular: Çalışmada, miyofasiyal ağrı nedeniyle ultrason eşliğinde trapezius kası interfasiyal bloku uygulanan 41’i kadın, 13’ü erkek toplam 54 hasta değerlendirildi. Hastaların işlem öncesi ortalama Numerik Rating Skala değerleri 7,16 (5–9) iken, iş- lemden 10 dakika sonra 3,31 (0–8) ve işlemden bir hafta sonra 3,37 (0–8) idi. İşlemden faydalanan hasta sayısı işlemden 10 dakika sonra 40 (%74,07) idi. İşlem sonrası bir haftaya kadar faydalanan hasta sayısı 38 (%70,37), 1–2 hafta arasında faydalanan hasta sayısı 36 (%66,66), 2 hafta-1 ay arasında faydalanan hasta sayısı 31 (%57,40), 1–3 ay arasında faydalanan hasta sayısı 26 (%48,14) ve 3 aydan daha uzun süre faydalanan hasta sayısı ise 17 (%31,48) olarak bulundu. Sonuç: Çalışmamızda hastaların çoğunda aylar süren bir ağrı rahatlaması elde ettik. Ultrason eşliğinde yapılan trapezius kası interfasiyal blokunun miyofasiyal ağrı sendromu tedavisinde etkili olabileceği kanaatindeyiz.

Results of ultrasound-guided interfascial block of the trapezius muscle for myofascial pain

Objectives: Myofascial pain syndrome (MPS) is a regional pain syndrome that causes pain due to hyperirritable trigger points in the musculoskeletal system. Trapezius is one of the most commonly affected muscles in MPS. We aimed to evaluate the ef- ficacy of an ultrasound-guided interfascial block of the trapezius muscle in patients with MPS. Methods: The records of patients who underwent an ultrasound-guided interfascial block of the trapezius between No- vember 2019 and October 2020 were retrospectively examined. The pain levels of the patients were evaluated with the numeric rating scale (NRS). Patients with a reduction in pain ≥50% after the procedure were considered to have benefited from the procedure. Results: A total of 54 patients (41 women and 13 men) were evaluated. The mean NRS values of the patients were 7.16 (5–9) before the procedure, 3.31 (0–8) 10 min after the procedure, and 3.37 (0–8) 1 week after the procedure. The number of patients who benefited from the procedure was 40 (74.07%) 10 min after the procedure. The number of patients who benefited from the procedure for up to 1 week, 1–2 weeks, 2 weeks–1 month, 1–3 months, and more than 3 months after the procedure was 38 (70.37%), 36 (66.66%), 31 (57.40%), 26 (48.14%), and 17 (31.48%), respectively. Conclusion: Pain relief lasting for months was achieved in most of the patients. We believe that ultrasound-guided interfascial block of the trapezius is effective for the treatment of MPS.

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1. Chou LW, Kao MJ, Lin JG. Probable mechanisms of needling therapies for myofascial pain control. Evid Based Comple- ment Alternat Med 2012;2012:705327.
2. Fleckenstein J, Zaps D, Rüger LJ, Lehmeyer L, Freiberg F, Lang PM, et al. Discrepancy between prevalence and per- ceived effectiveness of treatment methods in myofascial pain syndrome: Results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord 2010;11:32.
3. Simons DG. New views of myofascial trigger points: Etiol- ogy and diagnosis. Arch Phys Med Rehabil 2008;89:157–9.
4. Harden RN, Bruehl SP, Gass S, Niemiec C, Barbick B. Signs and symptoms of the myofascial pain syndrome: A na - tional survey of pain management providers. Clin J Pain 2000;16:64–72.
5. Gerwin RD. Classification, epidemiology, and natural his - tory of myofascial pain syndrome. Curr Pain Headache Rep 2001;5:412–20.
6. Skootsky SA, Jaeger B, Oye RK. Prevalence of myofascial pain in general internal medicine practice. West J Med 1989;151:157–60.
7. Fishbain DA, Goldberg M, Meagher RB, Steele R, Rosomoff H. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain 1986;26:181– 97.
8. Kaergaard A, Andersen JH. Musculoskeletal disorders of the neck and shoulders in female sewing machine opera- tors: Prevalence, incidence, and prognosis. Occup Environ Med 2000;57:528–34.
9. Kamanli A, Kaya A, Ardicoglu O, Ozgocmen S, Zengin FO, Bayik Y. Comparison of lidocaine injection, botulinum tox- in injection, and dry needling to trigger points in myofas- cial pain syndrome. Rheumatol Int 2005;25:604–11.
10. Yildirim MA, Öneş K, Gökşenoğlu G. Effectiveness of ultra- sound therapy on myofascial pain syndrome of the upper trapezius: Randomized, single-blind, placebo-controlled study. Arch Rheumatol 2018;33:418–23.
11. Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo mi- croanalytical technique for measuring the local biochemi- cal milieu of human skeletal muscle. J Appl Physiol (1985) 2005;99:1977–84.
12. Narvani AA, Tsiridis E, Kendall S, Chaudhuri R, Thomas P. A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surg Sports Traumatol Arthrosc 2003;11:403–8.
13. Hong CZ. Lidocaine injection versus dry needling to myo- fascial trigger point. The importance of the local twitch re- sponse. Am J Phys Med Rehabil 1994;73:256–63.
14. Domingo T, Blasi J, Casals M, Mayoral V, Ortiz-Sagristá JC, Miguel-Pérez M. Is interfascial block with ultrasound-guid- ed puncture useful in treatment of myofascial pain of the trapezius muscle? Clin J Pain 2011;27:297–303.
15. McDonnell JG, O’Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: A prospective ran- domized controlled trial. Anesth Analg 2007;104:193–7.
16. Hebbard P. Subcostal transversus abdominis plane block under ultrasound guidance. Anesth Analg 2008;106:674–5.
17. Park SM, Cho YW, Ahn SH, Lee DG, Cho HK, Kim SY. Com- parison of the effects of ultrasound-guided interfascial pulsed radiofrequency and ultrasound-guided interfascial injection on myofascial pain syndrome of the gastrocne- mius. Ann Rehabil Med 2016;40:885–92.
18. Benjamin M. The fascia of the limbs and back--a review. J Anat 2009;214:1–18.
19. Stecco A, Macchi V, Masiero S, Porzionato A, Tiengo C, Stec- co C, et al. Pectoral and femoral fasciae: Common aspects and regional specializations. Surg Radiol Anat 2009;31:35– 42.
20. Kang JJ, Kim J, Park S, Paek S, Kim TH, Kim DK. Feasibility of ultrasound-guided trigger point injection in patients with myofascial pain syndrome. Healthcare (Basel) 2019;7:118.
21. Han SC, Harrison P. Myofascial pain syndrome and trigger- point management. Reg Anesth 1997;22:89–101.
22. Maher RM, Hayes DM, Shinohara M. Quantification of dry needling and posture effects on myofascial trigger points using ultrasound shear-wave elas tography. Arch Phys Med Rehabil 2013;94:2146–50. 23. Vulfsons S, Ratmansky M, Kalichman L. Trigger point nee- dling: Techniques and outcome. Curr Pain Headache Rep 2012;16:407–12.
24. Jensen R, Rasmussen BK, Pedersen B, Olesen J. Muscle tenderness and pressure pain thresholds in headache. A population study. Pain 1993;52:193–9.
25. Thompson JM. The diagnosis and treatment of muscle pain syndromes. In: Braddom RL, editor. Physical Medicine and Rehabilitation. 2 nd ed. Philadelphia, PA: WB Saunders; 2000. p.934–56.
26. Alvarez DJ, Rockwell PG. Trigger points: Diagnosis and management. Am Fam Physician 2002;65:653–60.
27. Borg-Stein J, Simons DG. Focused review: Myofascial pain. Arch Phys Med Rehabil 2002;83(Suppl 1):S40–9.
28. French JL, McCullough J, Bachra P, Bedforth NM. Transver- sus abdominis plane block for analgesia after caesarean section in a patient with an intracranial lesion. Int J Obstet Anesth 2009;18:52–4.
29. Tran TM, Ivanusic JJ, Hebbard P, Barrington MJ. Determina- tion of spread of injectate after ultrasound-guided trans- versus abdominis plane block: A cadaveric study. Br J An- aesth 2009;102:123–7.
30. Kongsagul S, Vitoonpong T, Kitisomprayoonkul W, Tanti- siriwat N. Ultrasound-guided physiological saline injec - tion for patients with myofascial pain. J Med Ultrasound 2019;28:99–103.
31. Kumbhare D, Singh D, Rathbone H A, Gunn M, Grosman- Rimon L, Vadasz B, et al. Ultrasound-guided interventional procedures: Myofascial trigger points with structured lit - erature review. Reg Anesth Pain Med 2017;42:407–12.
32. Cho IT, Cho YW, Kwak SG, Chang MC. Comparison between ultrasound-guided interfascial pulsed radiofrequency and ultrasound-guided interfascial block with local anesthetic in myofascial pain syndrome of trapezius muscle. Medicine (Baltimore) 2017;96:e6019.