Huriye Gülistan BOZDAĞ BAŞKAYA, Ufuk ÇAĞIRICI

Künt Toraks Travması Sonrası Gelişen Multipl Kot Fraktürlerinde Ağrı Kontrolü İçin TENS (Transkutanöz Elektriksel Sinir Stimülasyonu)

Kot fraktürlerinde ağrının giderilmesi tedavinin temelini oluşturur. Bu çalışmayla, multipl kot fraktürü gelişen olgularda ağrı kontrolü için TENS etkinliği araştırıldı. Ege Üniversitesi Tıp Fakültesi Göğüs Cerrahisi Anabilim Dalı’nda, Eylül 2013-Ağustos 2014 tarihleri arasında, künt toraks travması nedeniyle multipl kot fraktürü bulunan, herhangi bir cerrahi girişim uygulanmamış 40 olgu çalışmaya dahil edildi. Hastalar TENS±analjezik ilaç uygulanan grup (Grup 1) ile sadece analjezik ilaç uygulanan grup (Grup 2) olmak üzere 2 gruba randomize edildi. Her iki grubun 0., 2., 6., 12., 24., 48. ve 72. saatlerdeki ağrı düzeyi vizüel analog skala (VAS) ile değerlendirildi. Grup 1’e 0. saatteki VAS>4 olanlara bir saat boyunca TENS uygulandı. Takip eden günlerde VAS>4 ise günde bir kez bir saat boyunca işlem tekrarlandı. İşleme rağmen VAS>4 olarak sürdüğünde tedaviye öncelikle non-steroid anti-inflamatuar ilaç (NSAİİ), gereğinde parasetamol eklendi. İkinci grupta 0. saat VAS≥4 olanlara sadece NSAİİ, gereğinde parasetamol verildi. Hastaların 0., 2., 6., 12., 24., 48. ve 72. saat VAS değerleri karşılaştırıldı. Her iki grupta da VAS değerlerinde azalma oldu, bu fark istatistiksel olarak anlamlı idi (p<0.05). Geliş VAS değeri (VAS_0) saatlere göre analiz edildiğinde ise, 24. saat hariç olmak üzere (p=0.933) tüm ölçüm yapılan saatlerde Grup 1 ile Grup 2 arasındaki fark istatistiksel olarak anlamlı bulundu (p<0.001). Grup 1’de NSAİİ kullanımının 24. saat hariç (p=0.287), diğer günlerde ve toplamda anlamlı derecede azaldığı görüldü (sırasıyla, p=0.001 ve p<0.001). Yan etkisi az ve kolay uygulanabilir bir yöntem olan TENS, multipl kot fraktürlerinde ağrıyı gidermede etkilidir. TENS ile NSAİİ analjezik ihtiyacı azalmaktadır. TENS’in etkisi 24. saatte azaldığından daha sık aralıklarla uygulanması önerilebilir.

Anahtar Kelimeler:

Göğüs Ağrısı, Kot Fraktürleri, TENS

TENS (Transcutaneous Electrical Nerve Stimulation) for Pain Control in Multiple Rib Fractures After Blunt Thoracic Trauma

Relief of pain in rib fractures is the basis of treatment. In this study, the effectiveness of TENS for pain control in patients with multiple rib fractures was investigated. Forty patients with multiple rib fractures due to blunt thoracic trauma, who did not undergo any surgical intervention, between September 2013 and August 2014 at Ege University Faculty of Medicine, Department of Thoracic Surgery were included in the study. The patients were randomized into 2 groups: TENS±analgesic drug administered group (Group 1) and analgesic drug-only group (Group 2). Pain level of both groups at 0, 2, 6, 12, 24, 48 and 72. hours was evaluated with visual analog scale (VAS). In group 1, TENS was applied for 1 hour to those with VAS>4 at hour 0. In the following days, if the VAS was>4, the procedure was repeated once a day for 1 hour. Non-steroidal anti-inflamatory drug (NSAID) and paracetamol as needed were added to the treatment when the VAS persisted as >4 despite the procedure. In the second group, only NSAID and paracetamol as needed were given with VAS≥4 at hour 0. The 0, 2, 6, 12, 24, 48 and 72. hours VAS values of the patients were compared. There was a decrease in VAS values in both groups, this difference was statistically significant (p<0.05). When 0.th hour VAS value was analyzed according to hours, the difference between Group 1 and Group 2 was statistically significant (p<0.001) at all hours of measurement, except for the 24th hour (p=0.933). It was observed that NSAID use decreased significantly in Group 1, except for the 24th hour (p=0.287), on other days and in total (p=0.001 and p<0.001, respectively). TENS, which has few side effects and is an easily applicable method, is effective in relieving pain in multiple rib fractures. With TENS, the need for NSAID analgesics is reduced. Since the effect of TENS decreases at the 24th hour, it may be recommended to apply it at more frequent intervals.

Keywords:

Chest Pain, Rib Fractures, TENS,

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