Prediktivni faktori nastanka i ishoda lečenja jakog postoperativnog bola kod bolesnika sa ugradnjom totalne endoproteze kuka

Abstract

Istraživanje je sprovedeno na specifičnoj populaciji pacijenata koja se najčešće podvrgava operacijama zamene zgloba kuka. Zbog prisutnih komorbiditeta, važno je prevenirati postoperativni bol kao faktor koji doprinosi razvoju postoperativnih komplikacija. Osnovni cilj je bio da se ispita uticaj D tipa ličnosti, anksioznosti i depresivnosti na pojavu jakog postoperativnog bola. Takođe je jedan od ciljeva istraživanja bio da se ispita uticaj faktora vezanih za operaciju na jak postoperativni bol kao i uticaj jakog postoperativnog na pojavu hroničnog bola.U studiju je uključeno 90 pacijenata koji su ulazili u studijsku ili kontrolnu grupu zavisno od jačine bola na numeričkoj rejting skali (NRS) od ≥ 5. Nakon operacije u spinalnoj anesteziji, postoperativni bol je tretiran ketorolakom ili morfinom ako je bio ˃ 5 na NRS. Pacijenti D tipa su praćeni i u odnosu na potrošnju morfina, ocenu i zadovoljstvo terapijom bola u odnosu na one koji nisu imali karakteristike D tipa. Nakon tri meseca pacijenti su intervjuisani u vezi sa postojanjem hroničnog postoperativnog bola. Subanalizom se došlo do zaključka da D tip, kao i kombinacija D tipa ličnosti i anksioznosti odnosno depresivnosti, daje još veću verovatnoću za jak postoperativni bol. Isto tako u ovom istraživanju, ženski pol i jak preoperativni bol su se pokazali bitnim. S druge strane, faktori rizika vezani za operaciju nisu bili od značaja. D tip ličnosti se može detektovati testom koji je jednostavan u uslovima anesteziološke kliničke prakse. Psihološka priprema ove grupe pacijenata i podrška okoline su bitni za bolji postoperativni ishod.

This study has been conducted on a specific group of patients that most frequently undergo the operation of hip joint replacement. Due to present comorbidities, it is important to prevent post-operative pain as a factor which contributes to the development of post-operative complications. The main objective has been the analysis of the impact of type D personality, anxiety and depression on the occurrence of strong post-operative pain. Also, one more objective of this research has been the analysis of the effect of factors related to operation on strong post-operative pain as well as the effect of strong post-operative pain on the occurrence of chronic pain. The study included 90 patients within the study and control groups depending on the intensity of pain on numerical rating scale (NRS) from > 5. After the operatin in spinal anesthesia, post-operative pain was treated with ketorolac and morphine if the intensity of pain was > 5 on NRS. Type D personality patients were also observed in relation to consumption of morphine, evaluation and satisfaction with the treatment of pain comparing to those not having the characteristics of type D personality. Three months later the patients were interviewed about the existence of chronic post-operative pain. By subanalysis the following conclusion has been reached : type D personality as well as the combination of type D personality and anxiety or depression, enhance the possibility of the occurrence of strong post-operative pain. Also, female gender and strong post-operative pain proved to play an important role. On the other hand, risk factors in relation to operation have not been taken into consideration. Type D personality can be detected by a test which is simple in the conditions of anaesthetic clinical practice. Psychological preparation of this group of patients and supportive surrounding are important factors for better post-operative outcome.