Geçirilmiş cerrahi müdahale sonrası fibromyalji sendromu tanısı alan hastalarda cerrahi skar dokularına uygulanan lokal anestezik enjeksiyonunun etkisinin değerlendirilmesi

Year 2019, Volume: 16 Issue: 1, 70 - 76, 22.03.2019

Turgay Altınbilek Sadiye Murat

Abstract

Amaç: Geçirilmiş
cerrahi müdahale sonrası fibromyalji sendromu (FMS) tanısı alan hastalarda
fizik tedaviye ek olarak skar dokularına lidokain enjeksiyonunun ağrı, depresyon ve fonksiyonel durumuna olan etkilerinin değerlendirilmesi
amaçlandı.  

Materyal ve Metod: Retrospektif çalışmaya 117 hasta (108 kadın, 9 erkek) arasından,
FMS tanısı konulmadan önce cerrahi operasyon geçirdiği saptanan 54 hasta (52 kadın, 2 erkek) içinde tedavileri
tamamlanan 45 kadın hasta çalışmaya dahil edildi. Hastalar fizik tedavi (FT)
alanlar ve fizik tedaviye ek skar dokularına lidokain enjeksiyonu yapılan
hastalar (FT+lidokain) olarak ayrıldı.

Tüm hastalara 15 seans boyun/sırt bölgelerine FT
uygulanmıştı (sıcak paket+TENS+terapötik ultrason). Lidokain enjeksiyonu 3
haftada 6 seans, ortalama 1 cm² skar dokusuna % 0.5’ lik 0.7 cc
lidokain olacak şekilde uygulanmıştı. Değerlendirme
parametreleri; ağrı ve sabah
tutukluğu [görsel analog skala (GAS)], hassas nokta
sayısı, depresyon düzeyi [Beck Depresyon ölçeği (BDÖ)], fonksiyonel değerlendirme [Fibromiyalji
Etki Ölçeği (FEÖ)] idi. Tedavi öncesi, tedavi sonrası veriler ve
tedavi sonrası 4-6 hafta sonra yapılan değerlendirmeler kaydedildi.

Bulgular: Çalışma FT alan 22, FT+enjeksiyon alan 23, toplam
45 olgu ile tamamlandı. Olguların hepsi kadındı, yaş ortalaması 40,69±5,51 yıldı.

Tedavi öncesinde gruplar
arasında demografik ve klinik değerlendirmeler açısından anlamlı fark yoktu (p>0,05). Grup içi değerlendirmelerde iki grupta tüm parametrelerde
anlamlı düzelme saptandı (p<0,01).

Gruplar arası
karşılaştırma değişim farkları değerlendirildiğinde ağrı, sabah tutukluğu, BDÖ,
FEÖ FT+Lidokain grubunda FT grubuna göre anlamlı olarak değişti. (p<0,01)

Sonuç: Geçirilmiş cerrahi müdahale sonrası fibromyalji sendromu (FMS) tanısı alan
kadın hastalarda hem FT, hem FT+lidokain tedavisi etkili tedavilerdir. FT+lidokain uygulanan hastalarda
tedavi ile sağlanan değişim ağrı, sabah tutukluğu şiddeti, depresyon ve
fonksiyonel durum açısından FT grubuna göre daha anlamlı iyilik sağladı.

Keywords

Fibromiyalji, lidokain, skar

Evaluation of the effect of local anesthetic injection on surgical scar tissues in patients diagnosed with fibromyalgia syndrome after surgical intervention

Abstract

Introduction: The aim of this study was to
evaluate the effects of lidocaine injection to scar tissues in addition to
physical therapy on pain, depression and functional status in patients
diagnosed with fibromyalgia syndrome (FMS) after surgery.

Method: In this
retrospective study, 45 female patients who completed their treatment out of 54
patients (52 females, 2 males) who were found to have undergone surgery prior
to the diagnosis of FMS out of 117 patients (108 females, 9 males) were
included. Patients were divided into groups of physical therapy (PT) and lidocaine
injection  to scar tissues in addition to
physical therapy (PT + lidocaine).

All patients underwent PT (hot pack + TENS + therapeutic
ultrasound) for 15 sessions to neck / back areas. Lidocaine injection was
performed 6 sessions in 3 weeks, with an average of 0.7 cc of  %0.5 lidocaine to 1 cm2 scar tissue. Evaluation
parameters; pain and morning stiffness [visual analogue scale (VAS)], number of
sensitive points, depression level [Beck Depression Inventory (BDI)],
functional evaluation [Fibromyalgia Impact Questionnaire (FIQ)]. Pre- and
post-treatment data and data 4-6 weeks after treatment were recorded.

Results: The study was completed with 22 of PT, 23 of
PT + injection, total 45 cases. All cases were women, with a mean age of 40.69
± 5.51 years.

There was no
significant difference between the groups in terms of demographic and clinical parameters
before the treatment (p> 0.05). Significant improvement was found in all
groups for all parameters (p <0.01).

When the differences
between the groups were compared, pain, morning stiffness, BDI, FIQ in  PT + Lidocaine group were significantly
changed compared to the PT group (p <0.01).

Conclusion: Both PT and
PT + lidocaine treatment are effective treatments in women with fibromyalgia
syndrome (FMS). In patients who underwent PT + lidocaine, the treatment
modality provided more significant well-being than the PT group in terms of
pain, severity of morning stiffness, depression and functional status.

Keywords

Fibromyalgia, lidocaine, scar

References

• KAYNAKLAR
• 1- Mountz JM, Bradley LA, Modell JG, Alexander RW, Triana M, Aaron LA, Mountz JD. (1995). Fibromyalgia in women. Arthritis & Rheumatism. 1995;38(7):926-38. 2-Bengtsson A. The muscle in fibromyalgia. Rheumatology.2002;41:721-4. 3-Wurtman RJ. Fibromyalgia and the complex regional pain syndrome: similarities inpathophysiology and treatment. Metabolism. 2010;59 (1):37–40. 4- Sívas FA, Başkan BM, Aktekin LA, Çinar NK, Yurdakul FG, Özoran K. Fibromiyalji hastalarında depresyon, uyku bozukluğu ve yaşam kalitesinin değerlendirilmesi. Turk J Phys Med Rehab .2009;55:8-12 5-Bellato E, Marini E, Castoldi F, Barbasetti N, Mattei L, Bonasia DE, et all. Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment. Pain Res Treat. 2012; 2012:429130. 6-Buskila D, Puttini PS. Biology and therapy of fibromiyalgia. Genetic aspects of fibromyalgia syndrome Arthritis Res Ther. 2006;8:218. 7-Ablin JN, Shoenfeld Y, Buskila D. Fibromyalgia, infection and vaccination: Two more parts in the etiological puzzle, J Autoimm. 2006;27: 145-52. 8-Abeles MA, Pillinger HM, Solitar MB, Abeles M. Narrative Review: The pathophysiology of fibromyalgia . Ann Intern Med. 2007;146:726-34. 9-Uslu T, Tosun M, Hansu N, Güler M, Madenci E. Primer fibromyalji sendromlu hastalarda geçirilmiş cerrahi müdahale, hekime başvurma ve ilaç tüketimi. Fiz Tıp Rehab Derg. 1997;21:41-4. 10-Wolfe F . Fibromyalgia. Rheum Diseases Clin North Am. 1990;16:681-98. 11-Ballantyne JC. Chronic Pain after Surgery or Injury. Pain. 2011;19:1. 12-Gill JM, Quisel A. Fibromyalgia and diffuse myalgia. Clin Family Practice. 2005;7:181-90. 13-RaphaeL JH, Southall JL, Treharne GJ, Kitas GD. Efficacy and adverse effects of intravenous lignocaine therapy in fibromyalgia syndrome. BMC Musculoskeletal Disord .2002;3:1-8. 14-Souza MF, Kraychete DC. The analgesic effect of intravenous lidocaine in the treatment of chronic pain: a literature review. Rev Bras Rheumatol. 2014;5:386–92. 15- Schafranski MD, Malucelli T, Machado F, Takeshi H, Kaiber F, Schmidt C, et all. Intravenous lidocaine for fibromyalgia syndrome: an open trial. Clin Rheumatol. 2009;28:853-5. 16-Dosch P. Manual of neural therapy according to Huneke. 2nd ed. New York, NY: Thieme Medical Publishers. 2007;P: 78-120. 17-Mermod J, Fischer L, Staub L, Busato A. Patient satisfaction of primary care for musculoskeletal diseases: a comparison between Neural Therapy and conventional medicine. BMC Complement Altern Med. 2008;8:33 doi: 10.1186/1472-6882-8-33. 18-Frank BL. Neural therapy: Review Article. Phys Med Rehabil Clin N Am. 1999;10:573-82. 19-Brobyn TL, Chung MK, LaRiccia PJ. Neural Therapy: An overlooked game changer forpatients suffering chronic pain? Review Article. J Pain Relief .2015;4:1-4. 20- Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et all. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990; 33;160-72 21- Wolfe F, Ross K, Anderson J, Russel J, Hebert L. The prevalance and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38:19-38. 22-Shupak MN, Mckay CJ, Nielson RW, Rollman BG, Prato SF, Thomas WWA. Pain Res Manege . 2006; Vol 11:2 23-Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561-71. 24-Hisli N. Beck depresyon envanterinin geçerliği üzerine bir çalışma. Psikoloji Dergisi .1988; 6:118-26 25-Burkhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: devolopment and validation J Rheumatol. 1991;18:728-33. 26-Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int. 2000;20: 9-12. 27- Bartlett EE, Hutaserani Q. Lidocaine (xylocaine) for the relief of postoperative pain. J Am Med Womens Assoc. 1962; 17:809-15. 28- Matzner O, Devor M. Hyperexcitability at sites of nerve injury depends onvoltage-sensitive Na channels. J Neurophysiol. 1994; 72:349-59. 29- Wall PD, Devor M. Sensory afferent impulses originate from dorsal root ganglia as well as from the periphery in normal and nerve injured rats. Pain .1983;17:321-39 30-Tremont-Lukats IW, Challapalli V, McNicol ED, Lau J, Carr DB. Systemic administration of local anesthetics to relieve neuropathic pain: A systematic review and meta-analysis. Anesth Analg. 2005; 101:1738-49. 31-Bennett MI, Tai YM. Intravenous lignocaine in the management of primary fibromyalgia syndrome. Int J Clin Pharmacol Res. 1995;15(3):115-9. 32-McCleane G. Does intravenous Lidokaine reduce fibromyalgia pain? Pain Clin .2000;12:181-5. 33-Posner IA. Treatment of fibromyalgia syndrome with intravenous lidocaine. J Musculoskeletal Pain. 1994;2:55-65 34- Kosharskyy B, Almonte W, Shaparin N, Pappagallo M, Smith H. Intravenous infusions in chronic pain management. Pain Physician. 2013;16(3):231-49.