Postoperatif ağrı sadece nosiseptif ağrı mıdır?

Cerrahi geçiren hastaların dörtte üçünde akut ağrı gelişmektedir. Bu ağrının büyük bir kısmıda kronik ağrı şekline dönüşmektedir. Postoperatif ağrının tedavisi günümüzde opioid ağırlıklı olarak yapılmaktadır. Ancak başarılı sonuçlar alınamamaktadır. Postoperatif ağrı cerrahi girişim nedeniyle oluşan doku hasarı ve kas spazmın birlikte olduğu bir ağrı olarak tanımlanmaktadır. Ancak postoperatif ağrı oluşum mekanizmalarında periferik ve santral sensitizasyonun gösterilmesi, postoperatif ağrı tedavisi için antikonvülzan ilaçların kullanılması ve elde edilen başarılı sonuçlar postoperatif ağrı pür nosiseptif bir ağrı mıdır sorusunu gündeme getirmektedir. Yine her cerrahi işlem de bir sinir hasarı söz konusu olduğuna göre postoperatif ağrının nöropatik ağrı karakterleri taşıması şaşırtıcı olmamalıdır. Tüm bunların ışığında postoperatif ağrıyı pür bir ağrı olarak değerlendirmek yerine nosiseptif, enflamatuvar ve nöropatik kompanentleri olan kombine bir ağrı olarak tanımlamak daha doğru olacaktır. Uygulanacak tedavide tüm bu kompanentleri kapsayacak şekilde planlanmalıdır.

Is postoperative pain only a nociceptive pain?

More than 75% of patients undergoing surgery suffer from acute pain. Most of this pain transforms into chronic pain. Currently, treatment of postoperative pain is based mainly on opioids, but results are not quite satisfactory. Postoperative pain is defined as a condition of tissue injury together with muscle spasm after surgery. Recently, peripheral and central sensitization has been shown within the mechanisms of postoperative pain generation. Accordingly, anti-convulsive drugs have been used successfully for the treatment of postoperative pain. Therefore, the issue of whether postoperative pain is purely a nociceptive pain remains a topic of debate. Considering that every surgical intervention might result in a nerve injury, it is not surprising to find neuropathic pain features within the postoperative pain itself. In light of these findings, it would be more precise to define postoperative pain as a combination of inflammatory and neuropathic components instead of as pure pain. Thus, the appropriate postoperative treatment should be planned involving both of these components.

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