Kamer DERE, Enis BİÇERER, Sezai ÖZKAN, Güner DAĞLI

Posttorakotomi ağrı sendromu tedavisinde Pasha-Cath® uygulaması

Posttorakotomi ağrı sendromu, torakotomi operasyonu geçiren hastaların %5-65’inde görülen bir kronik ağrı sendromudur. Genellikle interkostal sinir hasarına bağlı olan bir nöropatik ağrı olarak sınıflandırılır. Yirmi bir yaşındaki erkek hastanın, torakotomi operasyonundan sonra sağda sırtından koltuk altındaki kesi yeri boyunca yayılan ağrısının başladığı öğrenildi. Bu kesinin üzerindeki alanda allodini ve hiperaljezi saptandı. Vizüel Analog Skala (VAS) skoru 10 olarak değerlendirildi. Olguya medikal tedavide gabapentin ve amitriptilinin başlandı. Olgu 3 ay sonra değerlendirildiğinde ilaçları düzenli kullanamadığını ve ilaçlardan dolayı günlük hayatında işine konsantre olmakta güçlük çektiğinden yakınmaktaydı. Bunun üzerine medikal tedavisi tekrar planlandı. Olgunun şikayetlerinin devam etmesi üzerine Pasha-Cath ile epidural pulse radyo frekans tedavisi uygulanmasına karar verildi. VAS 3 hafta sonra 2 ve 3 ay sonra da 2 olarak devam etti. Olgu şu an işlem sorası 6. ayda olup VAS 2 olarak devam etmektedir. Sonuç olarak, posttorakotomi ağrı sendromunda medikal tedavinin yetersiz kaldığı durumlarda Pasha-Cath ile epidural pulse radyo frekans uygulamasıyla da etkin bir tedavi sağlanabileceği kanısındayız.

Pasha-Cath® in the treatment of post-thoracotomy pain syndrome

Post-thoracotomy pain syndrome is a chronic pain syndrome and is seen in approximately 5-65% of patients after thoracotomy. Post-thoracotomy pain syndrome is generally considered to be neuropathic pain due to intercostal nerve injury. A 21- year-old male patient experienced pain radiating along the incision after the thoracotomy operation. Allodynia and hyperalgesia were determined in the upper part of the incision; visual analogue scale (VAS) score was 10. Gabapentin and amitriptyline were started as medical treatment. Three months later, the patient complained of concentration difficulty at work and in daily life. Medical therapy was planned again. In view of the persisting complaints, epidural pulse radio frequency with Pasha-Cath was scheduled. After 3 weeks and also at 3 months, the VAS was 2. After 6 months, VAS remained at 2. As a result, we concluded that epidural pulse radio frequency with Pasha-Cath is an alternative and effective choice of treatment in post-thoracotomy pain syndrome when the medical treatment alone is not sufficient.

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