Obstetrik ve jinekolojik cerrahide transvers insizyonlarda iliohipogastrik sinirin sütur hattından uzaklaştırılmasının postoperatif ağrı üzerine etkisi : Randomize çift kör kontrollü çalışma
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada Pfannenstiel insizyonuyla yapılan keside, kesi lateral uçlarından yağlı doku ile birlikte ilioinguinal ve iliohipogastrik sinir uçlarının uzaklaştırılması sonrası postoperatif ağrının azaltılması ve hastanın yaşam kalitesinin yükseltilmesi amaçlanmıştır. Yöntem ve Gereç: Kliniğimizde Aralık 2022 - Şubat 2023 tarihleri arasında prospektif olarak yapılan bu çalışmada, Tekirdağ Namık Kemal Üniversite Hastanesi Kadın Hastalıkları ve Doğum kliniğinde Pfannenstiel insizyonuyla Sezaryen doğum operasyonu geçiren 46 gebe hasta dahil edilmiştir. Çalışmaya dahil edilme kriterlerine uyan gebe hastalar kabul edilmiştir. Çalışmamız, deney ve kontrol grubu olmak üzere iki grup üzerinde yapılmış olup, hastaların insizyon hattındaki postoperatif ağrıları Visual Analog Skala (VAS) skorlaması ve APS-POQ- R-TR ölçeği ile karşılaştırılmıştır. Bulgular: Çalışmamız gruplara göre değerlendirildiğinde olguların yaşları, kilo ve VKİ ölçümleri, gebelik haftaları, medeni durum ve eğitim durumu oranları , operasyondan önce ağrı görülme oranları , ameliyat tipleri, gruplara göre ağrı giderilmesi için ilaç dışı yöntem kullanımı ve ilaç dışı yöntem için teşvik sıklığı oranları arasında istatistiksel olarak anlamlı farklılık saptanmamıştır (p>0,05). Gruplara göre olgulara ağrı tedavisi ile ilgili bilgi verilme oranları arasında istatistiksel olarak anlamlı farklılık saptanmazken (p>0,05); verilen bilginin faydası gruplar arasında istatistiksel olarak anlamlı farklılık göstermektedir (p=0,018; p<0,05). Deney grubuna ağrı tedavisi ile ilgili verilen bilginin fayda puanı, kontrol grubundan anlamlı düzeyde düşük saptanmıştır. Gruplara göre olguların postop 1.gün VAS ağrı skorları arasında istatistiksel olarak anlamlı farklılık saptanmıştır (p=0,043; p<0,05); deney grubunun VAS skorları, kontrol grubundan daha düşüktür. Gruplara göre olguların postop 10.gün ve 1.ay VAS ağrı skorları istatistiksel olarak anlamlı farklılık göstermemektedir (p>0,05). Deney grubu olguların postop 1.gün, 10.gün ve 1.a VAS ağrı skorlarındaki değişim istatistiksel olarak anlamlı bulunmuştur (p=0,023; p<0,05). Yapılan ikili karşılaştırmalar sonucunda; olguların postop 1.güne göre postop 1.ay VAS ağrı skorlarındaki düşüş istatistiksel olarak anlamlı bulunmuştur (p=0,045; p<0,05). Olguların postop 1.güne göre postop 10.gün ve postop 10.güne göre postop 1.ay VAS ağrı skorlarındaki değişim ise anlamlı bulunmamıştır (p>0,05). Kontrol grubu olguların postop 1.gün, 10.gün ve 1.a VAS ağrı skorlarındaki değişim istatistiksel olarak anlamlı bulunmuştur (p=0,001; p<0,01). Yapılan ikili karşılaştırmalar sonucunda; olguların postop 1.güne göre 10.gün ve postop 1.ay VAS ağrı skorlarındaki düşüş 61 istatistiksel olarak anlamlı bulunmuştur (sırasıyla p=0,039; p=0,001; p<0,05). Olguların postop 10.güne göre postop 1.ay VAS ağrı skorlarındaki değişim ise anlamlı bulunmamıştır (p>0,05). Gruplara göre olguların ağrı şiddeti ve uyku bozukluğu puanları arasında istatistiksel olarak anlamlı farklılık saptanmıştır (p=0,009; p<0,01); deney grubunun ağrı şiddeti ve uyku bozukluğu puanları, kontrol grubundan daha düşüktür. Gruplara göre olguların aktiviteye etkisi puanları arasında istatistiksel olarak anlamlı farklılık saptanmıştır (p=0,012; p<0,05); deney grubunun aktiviteye etkisi puanları, kontrol grubundan daha düşüktür. Gruplara göre olguların Amerikan ağrı derneği ağrıya yönelik revize hasta bakım ölçeği toplam puanları arasında istatistiksel olarak anlamlı farklılık saptanmıştır (p=0,003; p<0,01); deney grubunun toplam puanları, kontrol grubundan daha düşüktür. Sonuç: Araştırmamızda, ilioinguinal ve iliohipogastrik sinirlerin pfanensteil insizyonla uzaklaştırılmasıyla postoperatif ağrının azaltılması amaçlanmıştır. Çalışmamız, pfanensteil insizyonda sinir sıkışmasının önlenmesi ve postoperatif ağrı yönetimi konusunda önemli bulgular sunmaktadır. Anahtar Kelimeler: Pfanensteil insizyon, ilioinguinal iliohipogastrik sinir uzaklaştırılması, postoperatif kasık ağrısı..
Objective: In this study, it was aimed to reduce postoperative pain and improve the quality of life of the patient after removal of the ilioinguinal and ilohypogastric nerve endings together with the fatty tissue from the lateral ends of the incision made with a pfhanensteil incision. Material and Methods: In the prospective study conducted in our clinic between December 2022 and February 2023; In this study, 46 pregnant patients who had a Caesarean section with a Pfhanensteil incision in Tekirdağ Namık Kemal University Hospital's Gynecology and Obstetrics Clinic were included. Pregnant patients who met the inclusion criteria were accepted. Our study was conducted on two groups, experimental and control groups, and postoperative pain at the incision line of the patients was compared with VAS scoring and APS-POQ-R-TR scale. Results: When our study was evaluated according to the groups, the ages of the cases, weight and BMI measurements, weeks of gestation, marital status and educational status rates, rates of pain before the operation, types of surgery, use of non-drug methods for pain relief and frequency of incentives for non-drug methods according to groups There was no statistically significant difference between them (p>0.05). While there was no statistically significant difference between the rates of giving information about pain treatment to the patients according to the groups (p>0.05); the usefulness of the information provided differs statistically between the groups (p=0.018; p<0.05). The benefit score of the information given to the experimental group about pain treatment was found to be significantly lower than that of the control group. A statistically significant difference was found between the postoperative 1st day VAS pain scores of the cases according to the groups (p=0.043; p<0.05); VAS scores of the experimental group are lower than the control group. According to the groups, the postoperative 10th day and 1st month VAS pain scores of the cases did not show a statistically significant difference (p>0.05). The change in the postoperative 1st day, 10th day and 1st day VAS pain scores of the experimental group cases was found to be statistically significant (p=0.023; p<0.05). As a result of paired comparisons; The decrease in the postoperative 1st month VAS pain scores of the cases compared to the postoperative 1st day was statistically significant (p=0.045; p<0.05). The change in VAS pain scores at postoperative 1st month compared to postoperative 1st day and postoperative 10th day and postoperative 10th day was not significant (p>0.05). The change in postoperative 1st day, 10th day and 1st day VAS pain scores of the control group cases was found to be statistically significant (p=0.001; p<0.01). As a result of paired comparisons; The decrease in VAS pain scores on the 10th day and postoperative 1st month compared to the postoperative 1st day was statistically significant (p=0.039; p=0.001; p<0.05, respectively). The change in the postoperative 1st month VAS pain scores of the cases compared to the postoperative 10th day was not significant (p>0.05). A statistically significant difference was found between the pain severity and sleep disorder scores of the cases according to the groups (p=0.009; p<0.01); The pain intensity and sleep disorder scores of the experimental group were lower than those of the control group. A statistically significant difference was found between the scores of the subjects' effect on activity according to the groups (p=0.012; p<0.05); The effect of the experimental group on the activity scores is lower than the control group. A statistically significant difference was found between the total scores of the American Pain Society's revised patient care scale for pain according to the groups (p=0.003; p<0.01); The total scores of the experimental group are lower than the control group. Conclusion: In our study, it is aimed to manage postoperative pain by preventing ilioinguinal and iliohypogastric nerve compression. Therefore, our study is a study that can be considered in the prevention of nerve compression in the pfanensteil incision and in the management of postoperative pain. Keywords: Pfanensteil incision , Ilioinguinal iliohypogtric nerve removal. Postoperative groin pain.
Objective: In this study, it was aimed to reduce postoperative pain and improve the quality of life of the patient after removal of the ilioinguinal and ilohypogastric nerve endings together with the fatty tissue from the lateral ends of the incision made with a pfhanensteil incision. Material and Methods: In the prospective study conducted in our clinic between December 2022 and February 2023; In this study, 46 pregnant patients who had a Caesarean section with a Pfhanensteil incision in Tekirdağ Namık Kemal University Hospital's Gynecology and Obstetrics Clinic were included. Pregnant patients who met the inclusion criteria were accepted. Our study was conducted on two groups, experimental and control groups, and postoperative pain at the incision line of the patients was compared with VAS scoring and APS-POQ-R-TR scale. Results: When our study was evaluated according to the groups, the ages of the cases, weight and BMI measurements, weeks of gestation, marital status and educational status rates, rates of pain before the operation, types of surgery, use of non-drug methods for pain relief and frequency of incentives for non-drug methods according to groups There was no statistically significant difference between them (p>0.05). While there was no statistically significant difference between the rates of giving information about pain treatment to the patients according to the groups (p>0.05); the usefulness of the information provided differs statistically between the groups (p=0.018; p<0.05). The benefit score of the information given to the experimental group about pain treatment was found to be significantly lower than that of the control group. A statistically significant difference was found between the postoperative 1st day VAS pain scores of the cases according to the groups (p=0.043; p<0.05); VAS scores of the experimental group are lower than the control group. According to the groups, the postoperative 10th day and 1st month VAS pain scores of the cases did not show a statistically significant difference (p>0.05). The change in the postoperative 1st day, 10th day and 1st day VAS pain scores of the experimental group cases was found to be statistically significant (p=0.023; p<0.05). As a result of paired comparisons; The decrease in the postoperative 1st month VAS pain scores of the cases compared to the postoperative 1st day was statistically significant (p=0.045; p<0.05). The change in VAS pain scores at postoperative 1st month compared to postoperative 1st day and postoperative 10th day and postoperative 10th day was not significant (p>0.05). The change in postoperative 1st day, 10th day and 1st day VAS pain scores of the control group cases was found to be statistically significant (p=0.001; p<0.01). As a result of paired comparisons; The decrease in VAS pain scores on the 10th day and postoperative 1st month compared to the postoperative 1st day was statistically significant (p=0.039; p=0.001; p<0.05, respectively). The change in the postoperative 1st month VAS pain scores of the cases compared to the postoperative 10th day was not significant (p>0.05). A statistically significant difference was found between the pain severity and sleep disorder scores of the cases according to the groups (p=0.009; p<0.01); The pain intensity and sleep disorder scores of the experimental group were lower than those of the control group. A statistically significant difference was found between the scores of the subjects' effect on activity according to the groups (p=0.012; p<0.05); The effect of the experimental group on the activity scores is lower than the control group. A statistically significant difference was found between the total scores of the American Pain Society's revised patient care scale for pain according to the groups (p=0.003; p<0.01); The total scores of the experimental group are lower than the control group. Conclusion: In our study, it is aimed to manage postoperative pain by preventing ilioinguinal and iliohypogastric nerve compression. Therefore, our study is a study that can be considered in the prevention of nerve compression in the pfanensteil incision and in the management of postoperative pain. Keywords: Pfanensteil incision , Ilioinguinal iliohypogtric nerve removal. Postoperative groin pain.
Açıklama
Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı
Anahtar Kelimeler
Kadın Hastalıkları ve Doğum, Obstetrics and Gynecology
