Spinal tüberkülozda (Pott Hastalığı) multimodal analjezi

Spinal tüberküloz (Pott Hastalığı) bel ağrısının nadir fakat morbidite oranı yüksek nedenlerinden biridir. Hastalarda hem somatik hem de nöropatik nitelikte siddetli ağrı olusabilir. 70 yasında, kadın hasta, 4 yıl önce Pott Hastalığı tanısı konulmus ve opere edilmis, siddetli ağrı sikayeti (VAS=10/10) ile kliniğimize basvurdu. MRG’de T7-T8 omurlarında siddetli yıkım, çökme ve sinir basısı mevcuttu. Hasta aynı nedenle 2 kez opere edilmisti. 100 mgr TTS fentanil, 400 mg/gün tramadol ve 4 gr/gün parasetamol kullanımına rağmen yeterli ağrı kontrolü sağlanamayan hastaya, 2x75 mg/gün pregabalin baslandı ve etkin doz olan 2x150 mg/gün’e çıkıldı. Hastanın 18. ay kontrolünde, 300 mg/gün pregabalin, 25 mgr fentanil TTS, 200 mg/gün tramadol, 2 gr parasetamol tedavisiyle hafif ağrısının (VAS: 2/10) olduğu, yürüteç yardımıyla yürüyebildiği ve günlük islerini kısmen yapabildiği saptandı. Olgumuz, Pott Hastalığı’nda multimodal analjezide pregabalinin kullanıldığı ilk olgu özelliğindedir.

Multimodal analgesia in spinal tuberculosis (Pott’s disease)

Spinal tuberculosis (Pott’s disease) is one of the causes for the low back pain that is rare but has high morbidity rate. Patients may have both somatic and neuropathic severe pain. A female patient aged 70-year who had been diagnosed and operated with Pott’s disease 4 years ago presented to our outpatient clinic with a compliant of severe pain (VAS=10/10). A MRI scan revealed a severe destruction at the level of T7-T8 spines with neural compression and collapse. The patient had undergone surgery twice for the same reason. Because of gr TTS fentanyl, tramadole 400minadequate pain control despite the use of 100 mg/day and paracetamol 4 g/day, she was started pregabalin twice daily, and thereafter the dose was up-titrated to 150 mg twice daily, the effective dose. In the month 18 followup visit, she had mild pain (VAS: 2/10), could walk with the aid of a walker and perform her daily activities partially with pregabalin g, tramadole 200 mg/day, paracetamol 2 g daily. Ourm300 mg/day, fentanyl TTS 25 case is the first one for treatment whom pregabalin was used as part of a multimodal analgesia in the treatment of Pott’s disease.

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