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Transkütan elektriksel sinir stimülasyonunun multipl kaburga kırıklarında ağrı ve komplikasyonları önlemedeki etkinliği

Yıl 2024, Cilt: 17 Sayı: 1, 1 - 5, 08.01.2024

Öz

Giriş: Künt toraks travmaları sonrası ortaya çıkan kaburga kırıkları şiddetli ağrıya neden olur. Ağrıya bağlı solunum yolu sekresyonlarının atılamaması, atelektazi ve pnömoni gibi ciddi komplikasyonlar ortaya çıkabilir. Bu çalışmamızda izole multiple kaburga kırıklı hastalarda Transkütan Elektriksel Sinir Stimulasyonu’nun (TENS) ağrıyı giderme, akciğer fonksiyonlarını düzeltme ve komplikasyonları önlemedeki etkinliğini araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmaya Mart 2021 ile Aralık 2022 arasında Göğüs Cerrahi Kliniğimizde yatarak tedavi gören, izole toraks travmalı 50 hasta dahil edildi. Hastalar İV (İntravenöz) Analjezi grubu ve TENS (Transcutaneous Electrical Nerve Stimulation) grubu olarak gruplara ayrıldı. Belirlenen analjezi yöntemi uygulandıktan sonra 30. dakikada, tedavinin 1. gününde, 2. gününde ve 3. gününde istirahat halinde VAS değeri ve oda havasında periferik oksijen satürasyonu ölçüldü. Üçüncü gün aynı zamanda istirahat halinde solunum fonksiyon testinde bulunan FEV1 değeri ölçüldü.
Bulgular: Çalışmaya katılan 50 hastanın 28’i erkek, 22’si ise bayan idi. Ortalama yaş 55.7 idi. Gruplar arası yapılan istatistiksel çalışmada grup 2’de komplikasyon oranı istatistiksel olarak anlamlı şekilde grup 1’den daha fazla idi. Ayrıca işlem sonrası 1. ve 3. gün VAS değerleri, 3. gün FEV1 değeri, 3. gün O2 saturasyonu ve ilave analjezi ihtiyacı açısından gruplar arasında istatistiksel açıdan anlamlı fark vardı. Diğer parametreler açısından gruplar arasında anlamlı bir fark yoktu.
Sonuç: TENS tedavisi komplike olmayan ve az sayıda kaburga kırığı olan hastaların ağrısını kontrol etmede etkili ve güvenilir bir yöntemdir. Ancak çok sayıda kaburga kırığı olan ve şiddetli ağrısı olan hastalarda tek başına kullanıldığında yetersiz kalmakta ve ilave analjezi ihtiyacı artmaktadır.

Kaynakça

  • 1. Henry TS, Kirsch J, Kanne JP, Chung JH, Donnelly EF, Ginsburg ME, et al. ACR Appropriateness Criteria Rib Fractures. J Thorac Imaging 2014;29:364-366.
  • 2. Kamry-Jones R., Jurkovich GJ. Blunt Chest Trauma. Curr Probl Surg. 2004;41:223-380.
  • 3. Senn-Reeves JN, Staffileno BA. Long-term Outcomes After Blunt Injury to the Boney Thorax. J Trauma Nurs. 2013;20:56-64.
  • 4. Galvagno SM, Smith CE, Varon AJ, et al. Pain management for blunt thoracic trauma: a joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surgery 2016;81:936-951.
  • 5. Ho AM, Karmakar MK, Critchley LAH. Acute pain management of patients with multiple fractured ribs: a focus on regional techniques. Current Opinion in Critical Care 2011;17:323-327.
  • 6. Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma.2003;54:615-625.
  • 7. Thiruvenkatarajan V, Cruz Eng H, Adhikary SD. An update on regional analgesia for rib fractures. Current Opinion in Anaesthesiology 2018;31:601-607.
  • 8. Zimmerman A. Fox S, Griffin R, Nelp T, Thomaz E, Mvungi M, et al. An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country, PLoS One 2020;15(10), e0240528.
  • 9. Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview’, Chinese Journal of Traumatology 2020;23(3):125-138.
  • 10. Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: A review and introduction of a bundled rib fracture management protocol’, Trauma Surgery & Acute Care Open 2017;2(1):1–7. 11. Kim M, Moore JE. Chest trauma: Current recommendations for rib fractures, pneumothorax, and other injuries’, Current Anesthesiology Reports 2020;10(1):61-68.
  • 12. Ekpe EE, Eyo C. Overview of blunt chest injury with multiple rib fractures’, British Journal of Medicine & Medical Research 2016;12(8):1-15.
  • 13. Farley P, Griffin RL, Jansen JO, Bosarge PL. Quantifying pain associated with rib fractures, Journal of Surgical Research 2020;246, 476-481.
  • 14. Pharaon KS, Marasco S, Mayberry J. Rib fractures, flail chest, and pulmonary contusion’, Current Trauma Reports 2015;1(4):237-242.
  • 15. Haenel JB, Moore FA, Moore EE, Sauaia A, Read RA, Burch JM. Extrapleural bupivacain for amelioration of multiple rib fracture pain. J Trauma. 1995;38:22-27.
  • 16. Benedetti F, Amanzio M, Casadio C, Cabvallo A, Cianci R, Giobbe R, et al. Postthoracoscopy pain: is TENS the answer? Ann Thorac Surg 1997;63:773-776. 17. Coşkun-Çelik E. Medulla spinalis yaralanmalı hastalardaki nöropatik ağrıya akupunktur benzeri TENS’in etkisi. Uzmanlık Tezi, 2005, İstanbul. 18. Köke AJ, Schouten JS, Lamerichs-Geelen MJ, Lipsch JS, Waltje EM, van Kleef M, et al. Pain reducing effect of three types of transcutaneous electrical nerve stimulation in patients with chronic pain: A randomized crossover trial. Pain 2004;108(1-2):36-42.
  • 19. DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA. Effectiveness of transcutaneous electrical nerve stimulation. Curr Rheumatol Rep 2008;10(6):492–499.
  • 20. Blackall GF. Physical methods of pain management. In: Raj PP, editor. Practical management of pain, 3rd ed. St Louis: Mosby Inc, 2000. p:523–543.
  • 21. Meyler WJ, De Jongste MJL, Rolf CAM. Clinical evaluation of pain treatment with electro stimulation: a study on TENS in patients with different pain syndromes. Clin J Pain 1994;10:22–27.
  • 22. Lewis B, Lewis D, Cumming G. The comparative analgesic efficacy of transcutaneous electrical nerve stimulation and a non-steroidal anti-inflammatory drug for painful osteoartritis. Br J Rheumatol 1994;33:455-460.
  • 23. Carroll D, Tramer M, McQuay H, Nye B, Moore A. Transcutaneous electrical nerve stimulation in labour pain: a systematic review. Br J Obstet Gynaecol 1997;104:169-175.
  • 24. VanderArk GD, McGrath KA. Transcutaneous electrical nerve stimulation in treatment of postoperative pain. Am J Surg 1975;130:338-340.
  • 25. Cooperman AM, Hall B, Mikalacki K, Hardy R, Sardar E. Use of transcutaneous electrical nerve stimulation in control of postoperative pain. Am J Surg 1977;133:185-187.
  • 26. Sloan JP, Muwanga CL, Waters EA, Dove AF, Dave SH. Multiple rib fractures: transcutaneous nerve stimulation versus conventional analgesia. Journal of Trauma-Injury Infection & Critical Care 1986;26(12):1120-1122.
  • 27. Oncel M, Sencan S, Yildiz H, Kurt N. Transcutaneous electrical nerve stimulation for pain management in patients with uncomplicated minor rib fractures. European Journal of CardioThoracic Surgery 2002;22(1):13-17.
  • 28. Ordog GJ. Transcutaneous electrical nerve stimulation versus oral analgesic: a randomized double-blind controlled study in acute traumatic pain. American Journal of Emergency Medicine 1987;5(1):6-10.
  • 29. Rooney SM, Jain S, Goldiner PL. Effect of transcutaneous nerve stimulation on postoperative pain after thoracotomy. Anesth Analg 1983;62:1010-1012.
  • 30. Stubbing JF, Jellicoe JA. Transcutaneous electrical nerve stimulation after thoracotomy. Pain relief and peak expiratory flow rate-a trial of transcutaneous electrical nerve stimulation. Anaesthesia 1988;43:296-298.

Transkütan elektriksel sinir stimülasyonunun multipl kaburga kırıklarında ağrı ve komplikasyonları önlemedeki etkinliği

Yıl 2024, Cilt: 17 Sayı: 1, 1 - 5, 08.01.2024

Öz

Rib fractures following blunt thoracic trauma cause severe pain. Serious complications such as inability to excrete respiratory secretions, atelectasis and pneumonia may occur due to pain. In this study, we aimed to investigate the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) in relieving pain, improving lung function and preventing complications in patients with isolated multiple rib fractures.
The study included 50 patients with isolated thoracic trauma who were hospitalised in our Thoracic Surgery Clinic between March 2021 and December 2022. Patients were divided into groups as IV (Intravenous) Analgesia group and TENS group. VAS value at rest and peripheral oxygen saturation in room air were measu-red at 30 minutes after the analgesia method was applied, on 1st, 2nd and 3rd days of the treatment. On the third day, FEV1 value in pulmonary function test at rest was also measured.
Of the 50 patients who participated in the study, 28 were male and 22 were female. The mean age was 55.7 years. In the statistical study between the groups, the complication rate in group 2 was statistically significantly higher than in group 1. In addition, there was a statistically significant difference between the groups in terms of post-procedure 1st and 3rd day VAS values, 3rd day FEV1 value, 3rd day O2 saturation and need for additional analgesia. There was no significant difference between the groups in terms of other parameters.
TENS therapy is an effective and reliable method to control pain in patients with uncomplicated and few rib fractures. However, when used alone in patients with multiple rib fractures and severe pain, it is inadequate and the need for additional analgesia increases.

Kaynakça

  • 1. Henry TS, Kirsch J, Kanne JP, Chung JH, Donnelly EF, Ginsburg ME, et al. ACR Appropriateness Criteria Rib Fractures. J Thorac Imaging 2014;29:364-366.
  • 2. Kamry-Jones R., Jurkovich GJ. Blunt Chest Trauma. Curr Probl Surg. 2004;41:223-380.
  • 3. Senn-Reeves JN, Staffileno BA. Long-term Outcomes After Blunt Injury to the Boney Thorax. J Trauma Nurs. 2013;20:56-64.
  • 4. Galvagno SM, Smith CE, Varon AJ, et al. Pain management for blunt thoracic trauma: a joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surgery 2016;81:936-951.
  • 5. Ho AM, Karmakar MK, Critchley LAH. Acute pain management of patients with multiple fractured ribs: a focus on regional techniques. Current Opinion in Critical Care 2011;17:323-327.
  • 6. Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma.2003;54:615-625.
  • 7. Thiruvenkatarajan V, Cruz Eng H, Adhikary SD. An update on regional analgesia for rib fractures. Current Opinion in Anaesthesiology 2018;31:601-607.
  • 8. Zimmerman A. Fox S, Griffin R, Nelp T, Thomaz E, Mvungi M, et al. An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country, PLoS One 2020;15(10), e0240528.
  • 9. Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview’, Chinese Journal of Traumatology 2020;23(3):125-138.
  • 10. Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: A review and introduction of a bundled rib fracture management protocol’, Trauma Surgery & Acute Care Open 2017;2(1):1–7. 11. Kim M, Moore JE. Chest trauma: Current recommendations for rib fractures, pneumothorax, and other injuries’, Current Anesthesiology Reports 2020;10(1):61-68.
  • 12. Ekpe EE, Eyo C. Overview of blunt chest injury with multiple rib fractures’, British Journal of Medicine & Medical Research 2016;12(8):1-15.
  • 13. Farley P, Griffin RL, Jansen JO, Bosarge PL. Quantifying pain associated with rib fractures, Journal of Surgical Research 2020;246, 476-481.
  • 14. Pharaon KS, Marasco S, Mayberry J. Rib fractures, flail chest, and pulmonary contusion’, Current Trauma Reports 2015;1(4):237-242.
  • 15. Haenel JB, Moore FA, Moore EE, Sauaia A, Read RA, Burch JM. Extrapleural bupivacain for amelioration of multiple rib fracture pain. J Trauma. 1995;38:22-27.
  • 16. Benedetti F, Amanzio M, Casadio C, Cabvallo A, Cianci R, Giobbe R, et al. Postthoracoscopy pain: is TENS the answer? Ann Thorac Surg 1997;63:773-776. 17. Coşkun-Çelik E. Medulla spinalis yaralanmalı hastalardaki nöropatik ağrıya akupunktur benzeri TENS’in etkisi. Uzmanlık Tezi, 2005, İstanbul. 18. Köke AJ, Schouten JS, Lamerichs-Geelen MJ, Lipsch JS, Waltje EM, van Kleef M, et al. Pain reducing effect of three types of transcutaneous electrical nerve stimulation in patients with chronic pain: A randomized crossover trial. Pain 2004;108(1-2):36-42.
  • 19. DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA. Effectiveness of transcutaneous electrical nerve stimulation. Curr Rheumatol Rep 2008;10(6):492–499.
  • 20. Blackall GF. Physical methods of pain management. In: Raj PP, editor. Practical management of pain, 3rd ed. St Louis: Mosby Inc, 2000. p:523–543.
  • 21. Meyler WJ, De Jongste MJL, Rolf CAM. Clinical evaluation of pain treatment with electro stimulation: a study on TENS in patients with different pain syndromes. Clin J Pain 1994;10:22–27.
  • 22. Lewis B, Lewis D, Cumming G. The comparative analgesic efficacy of transcutaneous electrical nerve stimulation and a non-steroidal anti-inflammatory drug for painful osteoartritis. Br J Rheumatol 1994;33:455-460.
  • 23. Carroll D, Tramer M, McQuay H, Nye B, Moore A. Transcutaneous electrical nerve stimulation in labour pain: a systematic review. Br J Obstet Gynaecol 1997;104:169-175.
  • 24. VanderArk GD, McGrath KA. Transcutaneous electrical nerve stimulation in treatment of postoperative pain. Am J Surg 1975;130:338-340.
  • 25. Cooperman AM, Hall B, Mikalacki K, Hardy R, Sardar E. Use of transcutaneous electrical nerve stimulation in control of postoperative pain. Am J Surg 1977;133:185-187.
  • 26. Sloan JP, Muwanga CL, Waters EA, Dove AF, Dave SH. Multiple rib fractures: transcutaneous nerve stimulation versus conventional analgesia. Journal of Trauma-Injury Infection & Critical Care 1986;26(12):1120-1122.
  • 27. Oncel M, Sencan S, Yildiz H, Kurt N. Transcutaneous electrical nerve stimulation for pain management in patients with uncomplicated minor rib fractures. European Journal of CardioThoracic Surgery 2002;22(1):13-17.
  • 28. Ordog GJ. Transcutaneous electrical nerve stimulation versus oral analgesic: a randomized double-blind controlled study in acute traumatic pain. American Journal of Emergency Medicine 1987;5(1):6-10.
  • 29. Rooney SM, Jain S, Goldiner PL. Effect of transcutaneous nerve stimulation on postoperative pain after thoracotomy. Anesth Analg 1983;62:1010-1012.
  • 30. Stubbing JF, Jellicoe JA. Transcutaneous electrical nerve stimulation after thoracotomy. Pain relief and peak expiratory flow rate-a trial of transcutaneous electrical nerve stimulation. Anaesthesia 1988;43:296-298.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Hıdır Esme 0000-0002-0184-5377

Mehmet Karaduman 0000-0003-0320-6189

Yayımlanma Tarihi 8 Ocak 2024
Gönderilme Tarihi 25 Mayıs 2023
Yayımlandığı Sayı Yıl 2024 Cilt: 17 Sayı: 1

Kaynak Göster

Vancouver Esme H, Karaduman M. Transkütan elektriksel sinir stimülasyonunun multipl kaburga kırıklarında ağrı ve komplikasyonları önlemedeki etkinliği. JSurgArts. 2024;17(1):1-5.

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