KRONİK POSTTORAKOTOMİ AĞRI SENDROMU; DERLEME

Kronik post torakotomi ağrı sendromu (KPAS); torakotomiden 2 ay sonra, devam eden kronikleşmiş ağrı olarak ifade edilmektedir. Minimal invaziv tekniklerin gelişmesiyle son yıllarda insidansında azalma olmakla birlikte, torakotomi geçiren olguların yarıya yakınında görülür. Hastaların günlük yaşamını ve yaşamsal fonksiyonlarını olumsuz yönde etkileyen, etyolojisi tam olarak aydınlatılamamış bir problemidir. Etyolojide en çok torakotomi sırasında ekartör basısı ve kot fraktürü oluşumu suçlanmaktadır. Bu yüzden amaca en uygun ve en az travmatik cerrahi yöntem seçilmelidir. Sendrom klinikte önemli bir hasta populasyonunu etkilemektedir. Tedavi birinci basamak tedavilerden, nöromodülasyon ve sinir bloklarına kadar uzanan geniş bir yelpazede multimodal olarak değerlendirilmelidir ve mutlaka kişiselleştirilmelidir.

CHRONIC POSTTHORACOTOMY PAIN SYNDROME, A REVIEW

Chronic postthoracotomy pain syndrome (CPPS); can explain as persisting chronic pain during two months after thoracotomy. In last years, CPPS is seen in approximately half of patients after thoracotomy although the decrease in incidence with the development of minimally invasive techniques. The pain affects the patient's daily lives and vital functions in a negative way. The exact mechanism for the pathogenesis of CPPS is still not clear. Most common etiological factors are retractor compression during thoracotomy and rib fracture formation. For this reason the most appropriate and least traumatic surgical procedure should be selected. The Syndrome affects a significant patient population in clinical. Therapy should be considered as multimodal which is varies from primary treatment to neuromodulation and nerve blocks in wide range and the treatment should be personalized.

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  • 1. Tiippana E, Nilsson E, Kalso E. Postthoracotomy pain after thoracic epidural analgesia: A prospective follow-up study. Acta Anaesthesiol Scand 2003; 47: 433-8.
  • 2. Pluijms WA, Steegers MAH, Verhagen AFTM Scheffer GJ, Wilder-Smith OH. Chronic postthoracotomy pain: A retrospective study. Acta Anaesthesiol Scand 2006; 50: 804-8.
  • 3. Rogers ML, Duffy JP. Surgical aspects of chronic post-thoracotomy pain. Eur J Cardiothorac Surg 2000; 18: 711-6.
  • 4. Blades B, Dugan DJ. War wounds of the chest observed at the Thoracic Surgery Center, WalterReed General Hospital. J Thorac Surg 1944; 13: 294-306.
  • 5. Wildgard K, Ravn J, Kehlet H. Chronic postthoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention. European J Cardio-thorac Surg 2009; 36: 170-80.
  • 6. Gottschalk A, Cohen SP, Yang S, Ochroch EA. Preventing and treating pain after thoracic surgery. Anesthesiology 2006; 104(3): 594–600.
  • 7. Gotoda Y, Kambara N, Sakai T, Kishi Y, Kodama K, Koyama T. The morbidity, time course and predictive factors for persistent postthoracotomy pain. Eur J Pain 2001; 5: 89-96.
  • 8. Klafta JM. Impact of acute pain and its management for thoracic surgical patients. Ferguson MK (Ed.). Thorac Surg Clin 2005: 849-65.
  • 9. Perttunen K, Tasmuthand T, Kalso E. Chronic pain after thoracic surgery: a follow-up study Acta Anaesthesiol Scand 1999; 43 (5): 563-7.
  • 10. Maguire MF, Ravenscroft A, Beggs D, Duffy JP. A questionnaire study investigating the prevalence of the neuropathic component of chronic pain after thoracic surgery. Eur J Cardiothorac Surg 2006; 29: 800-5.
  • 11. Ochroch EA, Gottschalk A, Augostides J, Carson KA, Kent L, MalayamanN. Long-term pain and activity during recovery from major thoracotomy using thoraci cepidural analgesia. Anesthesiology 2002; 97: 1234-44.
  • 12. Landreneau RJ, Wiechmann RJ, Hazelrigg SR, Mack MJ, Keenan RJ, Ferson PF. Effect of minimally invasive thoracic surgical approaches on acute and chronic post operative pain. Chest Surg Clin N Am 1998; 8(4): 891-907.
  • 13. Bachiocco V, Morselli-Labate AM, Rusticali AG, Bragaglia R, Mastrorilli M, Carli G. Intensity, latency and duration of post-thoracotomy pain: Relationship to personality traits. Funct Neurol 1990; 5(4): 321–32.
  • 14. Baron R, Binder A, Wasner G. Neuropathic pain: Diagnosis, pathophysiological mechanisms and treatment. Lancet Neurol 2010; 9: 807-19.
  • 15. d'Amours RH, Riegler FX, Little AG. Pathogenesis and management of persistent postthoracotomy pain. Chest Surg Clin N Am 1998; 8(3): 703-22.
  • 16. Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain 2005; 118: 289-305.
  • 17. Sudoh Y, Cahoon EE, Gerner P, Wang GK. Tricyclic antidepressants as long-acting local anesthetics. Pain 2003; 103: 49-55.
  • 18. Moulin D E, Clark, A J, Gilron I, Ware M A,Watson CP, Sessle BJ et all Pharmacological management of chronic neuropathic pain - Consensus statement and guidelines from the Canadian Pain Society Pain Research & Management : The Journal of the Canadian Pain Society 12.1 (Spring 2007): 13-21.
  • 19. Slinger PD, Campos JH. Anesthesia for thoracic surgery. In Miller RD, ed. Miller’sAnesthesia. 8th ed. Philadelphia: ElsevierSaunders 2015; 1942- 2006.
  • 20. Zin CS, Nissen LM, Smith MT, O'Callaghan JP, Moore BJ. An update on the pharmacological management of post-herpetic neuralgia and painful diabetic neuropathy. CNS Drugs 2008; 22: 417-42.
  • 21. Attal N, Cruccu G, Baron R, Haanpaa M, Hansson P, Jensen TS et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010; 17: 1113-88.
  • 22. Quilici S, Chancellor J, Lothgren M, Simon D, Said G, Le TK et al. Meta-analysis of duloxetine vs. pregabalin and gabapentin in thetreatment of diabetic peripheral neuropathic pain. BMC Neurol 2009; 9: 6.
  • 23. Senturk M, Ozcan PE, Talu GK, Kiyan E, Camci E, Ozyalcin S, et al. The effects of three different analgesia techniques on longterm post thoracotomy pain. Anesth Analg 2002; 94: 11–5.
  • 24. Obata H, Saito S, Fujita N, Fuse Y, Ishizaki K, Goto F. Epidural block with mepivacaine before surgery reduces long-term post thoracotomy pain. Can J Anaesth 1999; 46: 1127–32.
  • 25. Carrol EN, Badura AS. Focal intense brief transcutaneous electrical nerve stimulation for treatment of radicular and postthoracotomy pain. Arch Phys Med Rehabil 2001; 82: 262–4.
  • 26. Erdogan M, Erdogan A, Erbil N, Karakaya H, Demircan A. Prospective, Randomized, Placebo-controlled Study of the Effect of TENS on Postthoracotomy Pain and Pulmonary FunctionWorld J Surg (2005) 29: 1563–70.
  • 27. Fiorelli A., Morgillo F., Milione R., Pace M.C., Passavanti M.B., Laperuta P et al. Control of Post-Thoracotomy Pain by Transcutaneous Electrical Nerve Stimulation: Effect on Serum Cytokine Levels, Visual Analogue Scale, Pulmonary Function and Medication. European Journal of Cardio-Thoracic Surgery 2012; 40: 861–8.