Zeynep ÇAĞIRAN, Nezih SERTÖZ, Semra KARAMAN, Abdürrahim DERBENT, Ali ZEYDANOĞLU

Genel anestezi altında diz artroplastisi uygulanan hemofili hastalarında kronik ağrı

Amaç: Tekrarlayan eklem içi kanamalarıyla seyreden hemofilik artropati, erişkin hemofili hastalarında yaşam kalitesini belirleyen en önemli etkenlerken biridir. Bu artropatinin uzun dönemli etkileri sonucu operasyona alınanların, postoperatif dönemde karşılaştığı en önemli problem olan akut ağrı bazı durumlarda kronikleşmekte ve hastalarda uzun süren yakınmalara neden olmaktadır. Bu çalışmada diz artroplastisi uygulanmış hemofili hastalarında kronik ağrı gelişimini incelemeyi amaçladık. Gereç ve Yöntemler: Mart 2015 ile Aralık 2016 tarihleri arasında diz operasyonu geçiren hemofili hastaları retrospektif olarak incelendi. Postoperatif dönemde Ağrı Sorgulama Formu, Kısa Ağrı Envanteri ve Pain Detect Anketi kullanılarak kronik ağrının varlığı ve özellikleri, ağrının günlük yaşama etkisi ve hastaların analjezik kullanımı değerlendirildi. Bulgular: Çalışmaya dâhil edilen 42 hastada kronik ağrı insidansının %95,2 olduğu saptandı. Kısa Ağrı Envanteri ve Pain Detect Ağrı anketinin sonuçlarına göre maksimum Numerik Rating Skala değerleri nöropatik karakterde ağrısı olanlarda istatiksel olarak daha yüksek bulundu. Nöropatik karakterde ağrısı olanların olmayan gruba kıyasla istatiksel olarak daha genç yaşta olduğu görüldü. Sonuç: Hemofili hastalarında kronik ağrı insidansı oldukça yüksek düzeydedir. Bu hastaların ağrıya neden olabilecek altta yatan patolojileri, kanama riskleri, profilaksi tedavileri, ortopedik problemleri ve kronik ağrı gelişimine katkı sağlayan duygusal durumlarını da dikkate alan güncel ve kapsamlı yeni tanı yöntemleri kullanılmalı, tedavileri multidisipliner yaklaşımla uzmanlaşmış bir ekip tarafından gerçekleştirilmelidir.

Chronic pain in hemophilia patients with knee arthroplasty under general anesthesia

Aim: Hemophilic arthropathy with recurrent intra-articular bleedings is one of the most important factors determining the quality of life in adult hemophilia patients. Hemophilia patients are operated as a result of the long-term effects of such disorders. Acute pain, which is the most important problem faced by patients in the postoperative period, becomes chronic in some cases and causes long-lasting complaints in patients. Our aim in this study is to examine the occurrence of chronic pain in hemophilia patients who have undergone knee arthroplasty. Materials and Methods: Hemophilia patients who underwent knee surgery between March 2015 and December 2016 were retrospectively analyzed. In the postoperative period, the presence and characteristics of chronic pain, the effect of pain on daily life, and the use of analgesics by the patients were evaluated using the Pain Inquiry Form, Brief Pain Inventory, and Pain Detect Questionnaire. Results: The incidence of chronic pain in patients with hemophilia is quite high. According to the results of the Short Pain Inventory and Pain Detect Questionnaire, the maximum Numeric Rating Scale values were found to be statistically higher in patients with neuropathic pain. It was observed that those with neuropathic pain were statistically younger compared to the group without pain. Conclusions: The incidence of chronic pain in hemophilia patients is quite high. Current and comprehensive new diagnostic methods should be used, which also take into account their emotional state, which contributes to the development of chronic pain and the underlying pathologies that can cause pain, risks of bleeding, prophylaxis treatments, orthopedic problems; their treatment should be carried out by a specialized team with a multidisciplinary approach.

PDF

___

1. Montgomery RR, Scott P. Hemorhagic and Thrombotic Diseases. In: Behrman RE, Kliegman RM (eds). Nelson Textbook of Pediatrics. 19th edition. Philadelphia,:W.B Saunders; 2003: 1657–60.
2. Corrigan JJ. Hemorrahagic and thrombotic diseases. In:Nelson WE, Behrman RE, Kliegman RM, Arvin AM (eds). Nelson Textbook of Pediatrics. 7th edition. Philadelphia: WB Saunders; 1996: 1424-7.
3. Upchurch KS, Doreen BB. Hemophilic Arthropathy. In:Ruddy S, Harris ED, Sledge CB Eds. Kelley’s Textbook of Rheumatology. Philadelphia: WB Saunders; 2001: 1567-74.
4. Montgomery RR, Scott JP. Hemostasis. Diseases of the fluid phase. In: Nathan DG, Oski FA Eds. Hematology of Infancy and Childhood. Philadelphia: WB Saunders; 1992: 1613-20.
5. Jansen NWD, Roosendaal G, Lafeber FP. Understanding hemophilic arthropathy: an exploration of current open issues. Br J Hematol 2008; 143: 632-40.
6. Dunn AL. Pathophysiology, diagnosis and prevention of arthropathy in patients with hemophilia. Hemophilia 2011; 1-8.
7. Raffini L, Manno C. Modern management of hemophilic arthropathy. Br J Hematol 2007; 136: 777-87.
8. Rodriguez –Merchan EC, Jimenez-Yuste V, Aznar JA, Hedner U, et al. Joint protection in hemophilia. Hemophilia 2011; 17 (Suppl. 2): 1-23.
9. Rodriguez–Merchan EC. Management of Hemophilic Artropathy of the Ankle. Cardiovascular & Haematological Disorders-Drug Targets, 2017; 17.111-8.
10. Transition from acute to chronic pain: Evaluating risk for chronic postsurgical pain. Pain physcian 2019; 22: 479-88.
11. Macrae WA. Chronic post-surgical pain:10 years on. Br J Anaesth.2008; 101 (1): 77-86.
12. Humphries TJ, Kessler CM. Managing chronic pain in adults with hemophilia: current status and call to action. Haemophilia 2015; 21: 41-51.
13. Dicle A, Karayurt Ö, Dirimeşe E. Validation of the Turkish version of the Brief Pain Inventory in surgery patients. Pain Management Nursing. 2009; 10 (2):107-13.
14. Alkan H, Ardic F, Erdogan C et al. Turkish Version of the painDETECT Questionnaire in the Assessment of Neuropathic Pain: A Validity and Reliability Study. Pain Med. 2013; 14 (12): 1933-43.
15. Paredes AC, Costa P, Almeida A, et al. A new measure to assess pain in people with hemophilia: The Multidimensional Haemophilia Pain Questionaire (MHPQ). PLoS One; 2018;13(11):1-22.
16. Lambing A, Nichols CD, Munn JE,et al. Patient, caregiver, and provider perceptions of pain and pain management in adolescents and young adults with bleeding disorders. Haemophilia. 2017; 23: 852-60.
17. Kalnins W, Schelle G, Jost K, et al. Pain Therapy in Hemophilia in Germany, patient survey (BESTH Study). Hamostaseologie. 2015; 2 (35): 167-73.
18. Stromer W, Pabinger I, Ay C, et al. Pain Management in Hemophilia:expert recommendations. Wiener Klinische Wochenschrift. 2021; 133:1042-1056.
19. Auerswalda G, Dolanb G, Duffyc A, Hermansd c, et al. Blood Coagul Fibrinolysis. 2016 Dec; 27(8): 845–854.
20. Jasvinder AS, Sherine G and David L. The Impact of Gender, Age, and Preoperative Pain Severity on Pain After TKA. Clin Orthop Relat Res 2008; 466 (11): 2717–23.
21. Pinto PR, McIntyre T, Ferrero R, Araújo-Soares V and Almeida A. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact.. J Pain Res 2013; 6: 691–703.
22. Harden RN, Bruehl S, Stanos S et al. Prospective examination of pain-related and psychological predictors of CRPS-like phenomena following total knee arthroplasty: a preliminary study. Pain 2003; 106 (3): 393-400.
23. Van Genderen FR, Fischer K, Heijnen L et al. Pain and functional limitations in patients with severe haemophilia. Haemophilia 2006; 12 (2): 147-53.
24. Windyga J, Lopaciuk S, Stefanska E et al. Haemophilia in Poland. Haemophilia 2006; 12 (1): 52-7.
25. Haroutiunian S, Nikolajsen L, Finnerup NB, Jensen TS. The neuropathic component in persistent postsurgical pain: a systematic literature review. Pain 2013; 154 (1): 95-102.
26. Levchenko OK, Shulutko EM, Zorenko VY, Galstyan GM. The specific features of pain syndrome in patients with hemophilia. Ter Arkh. 2016; 88 (7): 84-8.
27. Santavirta N, Bjorvell H, Solovieva S, Alaranta H, Hurskainen K, Konttinen YT. Coping strategies, pain, and disability in patients with hemophilia and related disorders. Arthritis Rheum. 2001; 45 (1): 48–55.
28. Elander J, Barry T. Analgesic use and pain coping among patients with haemophilia. Haemophilia 2003; 9: 202–13.
29. Auerswald G, Dolan G, Duffy A et al. Pain and pain management in haemophilia. Blood Coagulation and Fibrinolysis. 2016; 27 (8): 845–54.
30. Flood E, Pocoski J, Michaels LA, McCoy A, Beusterien K, Sasanè R. Patient-reported experience of bleeding events in haemophilia. Eur J Haematol 2014; 93 (75): 19–28.
31. World Federation of Hemophilia. The pain management book for people with hemophilia and related bleeding disorders. Hemophilia Foundation Australia World Federation of Hemophilia 2000; 22: 2–7.
32. Wang T, Zhang L, Zhao H,Yang R. Assessing helath-related quality-of-life in individuals with haemophilia in China. Haemophilia 2004; 10 (4): 370-5.
33. Hartl HK, Reitter S, Eidher U, Ramschak H, Ay C, Pabinger I. The impact of severe haemophilia on the social status and quality of life among Austrian haemophiliacs. Haemophilia 2008; 14 (4): 703-708
34. Holstein K, Klamroth R, Richards M, Carvalho M, Pe´ rez-Garrido R, Gringeri A. Pain management in patients with haemophilia: a European survey. Haemophilia 2012; 18: 743–752