ABDURRAHİM DERBENT, Berna YILMAZ, Meltem UYAR

Omurga cerrahisi sonrası kronik ağrı

Omurga cerrahisi girişimlerinde son yıllarda bir artma eğilimi mevcuttur. Omurga cerrahisi sonrası postoperatif kronik ağrı omurilikteki bazı bölümlerin veya sinirlerin bası altında kalmasına bağlı, omurgadaki hasar veya instabiliteye bağlı gelişebilir, ya da enflamasyon, enfeksiyon ve tümörün yol açtığı uzamış nosisepsiyona bağlı olabilir. Cerrahi girişim sonrasında 3-6 aydan fazla süren ağrı postoperatif kronik ağrı olarak tanımlanabilir. Herhangi bir tipteki kronik ağrı ile başetmek oldukça zordur. Kronik postoperatif ağrı, non-steroid antienflamatuvar ilaçlarla, parasetamol, antikonvülzanlar ve sinir blokları, santral bloklarla tedavi edilebilir.

Chronic pain following spine surgery

There has been an increasing trends in the procedures of spine surgery in recent years. Postoperative chronic pain in spine surgery can be caused by damage or instability of spinal column; pressure on nerves or segment of spinal cord; or can be due to long lasting nociception caused by inflammation, infection or tumour. Pain that lasts longer than 3-6 months after surgery can be define as postoperative chronic pain. The incidence of postoperative chronic pain after surgical procedures, was between 10-50%. Coping with any type of chronic pain is quite difficult. Chronic postoperative pain can be treated with: NSAIDs, paracetamol, opioids, anticonvulsants and invasive technics such as nerve blocs, central blocs.

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1. Hughey AB, Lesniak MS, Ansari SA, Roth S. What will anesthesiologists be anesthetizing? Trends in neurosurgical procedure usage. Anesth Analg 2010;110(6):1686-97.
2. Klimek M, Ubben JF, Ammann J, Borner U, Klein J, Verbrugge SJ. Pain in neurosurgically treated patients: a prospective observational study. J Neurosurg 2006;104(3):350-9.
3. Sumpton JE, Moulin DE. Treatment of neuropathic pain with venlafaxine. Ann Pharmacother 2001;35(5):557-9.
4. Tremont-Lukats IW, Megeff C, Backonja MM. Anticonvulsants for neuropathic pain syndromes: mechanisms of action and place in therapy. Drugs 2000;60(5):1029-52.
5. Akkaya T, Ozkan D. Chronic post-surgical pain. Agri 2009;21(1):1-9.
6. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006;367(9522):1618- 25.
7. King JS. Dexamethasone--a helpful adjunct in management after lumbar discectomy. Neurosurgery 1984;14(6):697-700.
8. Wong GT, Yuen VM, Chow BF, Irwin MG. Persistent pain in patients following scoliosis surgery. Eur Spine J 2007;16(10):1551-6.
9. Shipton E. Post-surgical neuropathic pain. ANZ J Surg 2008;78(7):548-55.
10. Jaffe RA, Samuels SI. Anesthesiologist’s manual of surgical procedures. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 401-30.
11. Urban MK, Ya Deau JT, Wukovits B, Lipnitsky JY. Ketamine as an adjunct to postoperative pain management in opioid tolerant patients after spinal fusions: a prospective randomized trial. HSS J 2008;4(1):62-5.
12. Manchikanti L, Singh V, Cash KA, Pampati V, Datta S. Management of pain of post lumbar surgery syndrome: one-year results of a randomized, double-blind, active controlled trial of fluoroscopic caudal epidural injections. Pain Physician 2010;13(6):509-21.
13. Pöpping DM, Zahn PK, Van Aken HK, Dasch B, Boche R, Pogatzki- Zahn EM. Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth 2008;101(6):832- 40.
14. North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery 2005;56(1):98-107.
15. Bernard JM, Surbled M, Lagarde D, Trennec A. Analgesia after surgery of the spine in adults and adolescents. Cah Anesthesiol 1995;43(6):557-64.
16. Gao YJ, Ji RR. Targeting astrocyte signaling for chronic pain. Neurotherapeutics 2010;7(4):482-93.
17. Puolakka K, Ylinen J, Neva MH, Kautiainen H, Häkkinen A. Risk factors for back pain-related loss of working time after surgery for lumbar disc herniation: a 5-year follow-up study. Eur Spine J 2008;17(3):386-92.
18. Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain management. Yale J Biol Med 2010;83(1):11- 25.
19. Jirarattanaphochai K, Jung S. Nonsteroidal antiinflammatory drugs for postoperative pain management after lumbar spine surgery: a meta-analysis of randomized controlled trials. J Neurosurg Spine 2008;9(1):22-31.
20. Panchal SJ, Damaraju CV, Nelson WW, Hewitt DJ, Schein JR. System-related events and analgesic gaps during postoperative pain management with the fentanyl iontophoretic transdermal system and morphine intravenous patient-controlled analgesia. Anesth Analg 2007;105(5):1437-41.
21. Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg 2007;104(6):1545-56.
22. Dholakia C, Beverstein G, Garren M, Nemergut C, Boncyk J, Gould JC. The impact of perioperative dexmedetomidine infusion on postoperative narcotic use and duration of stay after laparoscopic bariatric surgery. J Gastrointest Surg 2007;11(11):1556-9.
23. Piletta P, Porchet HC, Dayer P. Central analgesic effect of acetaminophen but not of aspirin. Clin Pharmacol Ther 1991;49:350-4.