Çağatay KÜÇÜKBİNGÖZ, Fidan MARUFOGLU, Tamer BAYRAM, Ayşe BAHŞİ, Hayri ÖZBEK

TORAKAL DORSAL KÖK GANGLİYONU PULSED RADYOFREKANS UYGULAMASININ ETKİNLİĞİNİN POSTHERPETİK NEVRALJİ İLE POSTTORAKOTOMİ AĞRI SENDROMLARI ÜZERİNE ETKİLERİNİN KARŞILAŞTIRILMASI

GİRİŞ: Herpes zoster (HZ), dorsal root ganglion ve periferik sinirin inflamasyonuna ve desendan duyu siniri boyunca lokal doku yaralanmasına neden olan reaktive varisella-zoster virüsünden kaynaklanır. HZ, uzun süreli ağrı, yani postherpetik nevralji (PHN) ile komplike olabilen şiddetli ve ağrılı döküntülere neden olur. Post-torakotomi ağrı sendromu (PTPS), International Association for the Study of Pain (IASP) tarafından “cerrahi işlemden en az iki ay sonra torakotomi insizyonu boyunca tekrarlayan veya devam eden ağrı” olarak tanımlanmaktadır⁸. GEREÇ ve YÖNTEM: Hastaların medikal kayıtları Algoloji bilim dalı arşivindeki hasta dosyalarından yaş, cinsiyet, taraf, torakal seviye, ağrı nedeni, VAS ve DN4 skorları taranmıştır. Floroskopi eşliğinde girişim yapıldıktan sonra her biri 2 dakikalık 2 döngü PRF verilip, PRF her 500 ms'de 20 ms pulsed uygulandı. İşlem sonrasında her bir uygulama DRG seviyesinde RF kanülden 4 mg deksametazon, 20 mg lidokain, 5 mg bupivakain ve toplam 5 ml olacak şekilde izotonik solüsyonu eklendi. SONUÇ: Çalışmaya 25 erkek (%62,5), 15 kadın (%37,5) olmak üzere, toplam 40 hasta dahil edildi. Hastaların ortalama yaşı 60.5±12.4 yıl, ortanca ağrı süreleri 2 yıldı (0.2-15 yıl) . Ağrı etyolojisine göre postherpetik nevralji ve post-torakotomi ağrı sendromu grubu kıyaslandığında tedavi öncesi VAS değerleri istatistik olarak farklı değilken (p=0.129), tedavi sonrasında post-torakotomi ağrı sendromu grubunun VAS sonucunun istatistik anlamlı olarak daha düşük olduğu saptandı(p=0.001). TARTIŞMA: Çalışmamızda DRG PRF tedavisinin kronik torasik ağrı nedenleri üzerine etkinliğini ve farklı etyolojilerde etki düzeyini araştırmayı amaçladık ve Pulsed RF tedavisinin Posttorakotomi hastalarında Postherpetik nevraljiye göre daha etkin bir tedavi olduğu sonucuna ulaştık. Ayrıca yaş, cinsiyet, taraf gibi faktörlerin tedaviye anlamlı bir etkisi olmadığını gördük.

Anahtar Kelimeler:

Postherpetik nevralji, posttorakotomi ağrı sendromu, pulsed radyofrekans, torakal dorsal kök gangliyonu

Investigation of the Effects of Pulsed Radiofrequency Application of the Thoracal Dorsal Root Ganglion on Postherpetic Neuralgia and Post-thoracotomy Pain Syndromes

Aim: The causative agent of herpes zoster (HZ) is the reactivated varicella-zoster virus. HZ leads to severe and painful rashes that can be accompanied by long-term pain, i.e., postherpetic neuralgia (PHN). According to the International Association for the Study of Pain (IASP), post-thoracotomy pain syndrome (PTPS) is defined as “recurrent or persistent pain along the thoracotomy incision at least two months after surgery”⁸. Methods: In this study, the medical records of all the patients were reviewed for age, gender, size, thoracic level, cause of pain, and visual analog scale (VAS) and DN4 scores from the patient files maintained in the archive of the Department of Algology. Two cycles of pulse radiofrequency (PRF) were administered for 2 min each. Then, a total of 5 ml of dexamethasone, lidocaine, bupivacaine, and isotonic solutions of 4 mg, 20 mg, 5 mg, and 5 mg, respectively, were added through the RF cannula at the DRG level in each application. Results: In total, 40 patients, including 25 men (62.5%) and 15 women (37.5%), were analyzed in this study. The mean age of the patients was 60.5 ± 12.4 years, and the median duration of pain was 2 years (0.2–15 years). When PHN and PTPS groups were compared on the basis of the pain etiology, the VAS values before treatment were not statistically different (p = 0.129), whereas the VAS values after treatment were significantly lower in the PTPS group than in the PHN group (p = 0.001). Conclusions: This study aimed to investigate the effectiveness of DRG PRF therapy on the causes of chronic thoracic pain and in different etiologies. The results revealed that PRF therapy is more effective in treating patients with PTPS than those with PHN. We also found that factors such as age, gender, and size did not significantly affect the treatment. Keywords: Postherpetic neuralgia, post-thoracotomy pain syndrome, pulsed radiofrequency

Keywords:

Postherpetic neuralgia, post-thoracotomy pain syndrome, pulsed radiofrequency,

PDF

___

1.Yawn BP, Gilden D. The global epidemiology of herpes zoster. Neurology. 2013; 81: 928–30. https://doi.org/10.1212/WNL.0b013e3182a3516e
2.Mallick-Searle T, Snodgrass B, Brant JM. Postherpetic neuralgia: epidemi-ol¬ogy, pathophysiology, and pain management pharmacology. J Multidiscip Healthc. 2016; 9: 447–54. https://doi.org/10.2147/JMDH.S106340
3.Kawai K, Gebremeskel BG, Acosta CJ. A systematic review of incidence and complications of herpes zoster: toward a global perspective. BMJ Open. 2014;4:e004833. https://doi.org/10.1136/bmjopen-2014-004833
4.Forbes HJ, Bhaskaran K, Thomas SL et al. Quantification of risk factors for postherpetic neuralgia in herpes zoster patients, a cohort study. Neurology. 2016; 87: 94–102. https://doi.org/10.1212/WNL.0000000000002808
5.Varghese L, Standaert B, Olivieri A et al. The temporal impact of aging on the burden of herpes zoster. BMC Geriatr. 2017; 17: 30. https://doi.org/10.1186/s12877-017-0420-9
6.Nilsson J, Cassel T, Lindquist L. Burden of herpes zoster and post-herpetic neuralgia in Sweden. BMC Infect Dis. 2015; 15: 215. https://doi.org/10.1186/s12879-015-0951-7
7.Zhu Q, Zheng H, Qu H et al. Epidemiology of herpes zoster among adults aged 50 and above in Guangdong, China. Hum Vaccin Immunother. 2015; 11: 2113–8. https://doi.org/10.1080/21645515.2015.1016672
8.Blichfeldt-Eckhardt MR, Andersen C, Ørding H et al. From acute to chronic pain after thoracic surgery: the significance of different components of the acute pain response. J Pain Res. 2018; 11: 1541–8. https://doi.org/10.2147/JPR.S161303
9.Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101:77–86. https://doi.org/10.1093/bja/aen099
10.Maguire MF. A questionnaire study investigating the prevalence of the neu¬ropathic component of chronic pain after thoracic surgery. Eur J Cardio¬tho¬rac Surg. 2006; 29: 800–5. https://doi.org/10.1016/j.ejcts.2006.02.002
11.Pogatzki-Zahn EM, Segelcke D, Schug SA. Postoperative pain-from mech¬a¬nisms to treatment. Pain Rep. 2017; 2: e588. https://doi.org/10.1097/PR9.0000000000000588
12.Katz J. Acute pain after thoracic surgery predicts long-term post-thora-cot¬omy pain. Clin J Pain. 1996; 12: 50–5. https://doi.org/10.1097/00002508-199603000-00009
13.Dworkin RH, McDermott MP, Raja SN. Preventing chronic postsurgical pain: how much of a difference makes a difference? Anesthesiology. 2010; 112: 516–8. https://doi.org/10.1097/ALN.0b013e3181cf4253
14.Brulotte V, Ruel MM, Lafontaine E et al. Impact of pregabalin on the oc-cur¬rence of post-thoracotomy pain syndrome: a randomized trial. Reg Anesth Pain Med. 2015; 40: 262–9. https://doi.org/10.1097/AAP.0000000000000241
15.Wijayasinghe N, Duriaud HM, Kehlet H et al. Ultrasound-guided inter-costobrachial nerve blockade in patients with persistent pain after breast cancer surgery: a pilot study. Pain Physician. 2016; 19: E309–E318. PMID: 27008295
16.Gabriel RA, Finneran JJ, Swisher MW et al. Ultrasound-guided percutane¬ous intercostal cryo-analgesia for multiple weeks of analgesia following mas¬tec¬tomy: a case series. Korean J Anesthesiol. 2020; 73: 163–8. https://doi.org/10.4097/kja.19332
17.Graybill J, Conermann T, Kabazie AJ et al. Spinal cord stimulation for treat¬ment of pain in a patient with post-thoracotomy pain syndrome. Pain Physi¬cian. 2011; 14: 441–5.
18.Karmakar MK. Thoracic paravertebral block. Anesthesiology. 2001; 95: 771–80. https://doi.org/10.1097/00000542-200109000-00033
19.Deer TR, Levy RM, Kramer J et al. Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and cau¬salgia at 3 and 12 months: a randomized comparative trial. Pain. 2017; 158: 669–81. https://doi.org/10.1055/a-1009-0066
20.Malik K, Benzon HT, Warner DS, et al. Radiofrequency applications to dor¬sal root ganglia: a literature review. Anesthesiology. 2008; 109: 527–42. https://doi.org/10.1097/ALN.0b013e318182c86e
21.Cosman ER Jr, Cosman ER Sr. Electric and thermal field effects in the tis-sue around radiofrequency electrodes. Pain Med. 2005; 6: 405–24. https://doi.org/10.1111/j.1526-4637.2005.00076.x
22.Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009; 84: 274–80. https://doi.org/10.4065/84.3.274
23.Hagiwara S, Iwasaka H, Takeshima N, et al. Mechanisms of analgesic ac-tion of pulsed radiofrequency on adjuvant-induced pain in the rat: roles of de¬scending adrenergic and serotonergic systems. Eur J Pain. 2009; 13: 249–52. https://doi.org/10.1016/j.ejpain.2008.04.013
24.Racz GB, Ruiz-Lopez R. Radiofrequency procedures. Pain Pract. 2006; 6: 46–50. https://doi.org/10.1111/j.1533-2500.2006.00058.x
25.Ding Y, Li H, Hong T, et al. Efficacy and safety of computed tomography-guided pulsed radiofrequency modulation of thoracic dorsal root ganglion on herpes zoster neuralgia. Neuromodulation. 2019; 22: 108–14. https://doi.org/10.1111/ner.12858
26.Kim K, Jo D, Kim E. Pulsed radiofrequency to the dorsal root ganglion in acute herpes zoster and postherpetic neuralgia. Pain Physician. 2017; 20: E411.
27.Cohen SP, Sireci A, Wu CL, et al. Pulsed radiofrequency of the dorsal root gan¬glia is superior to pharmacotherapy or pulsed radiofrequency of the in¬ter¬costal nerves in the treatment of chronic postsurgical thoracic pain. Pain physician. 2006; 9: 227.