Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Shoulder-type Pain Formation After Spinal Anesthesia and the Effect of Non-invasive Method on Pain Reduction
Spinal Anestezi Sonrası Gelişen Omuz Tipi Ağrı Oluşumu ve Non-invaziv Yöntemin Ağrının Azaltılmasına Olan Etkisi
Derya KANZA GÜLa, Ayça SOLT KIRCAb
aDepartment of Gynecology and Obstetrics, İstanbul Medipol University Faculty of Medicine, İstanbul, TURKEY
bDepertment of Midwifery, Kırklareli University School of Health, Kırklareli, TURKEY
Turkiye Klinikleri J Health Sci. 2021;6(2):249-56
doi: 10.5336/healthsci.2020-75830
Article Language: EN
Full Text
ABSTRACT
 Objective: The effect of maternal up-head position on post-operative shoulder type pain (STP) during cesarean performed with spinal anesthesia and we planned it as a randomized controlled experimental study to evaluate the effectiveness of non-pharmacological methods in treatment. Material and Methods: Four hundred primiparous pregnant women who would undergo cesarean surgery with spinal anesthesia in the obstetrics service of a Private Nisa Hospital in İstanbul between February and August 2019 were included in the study. The participants were divided into two groups as head up position (n=200) and horizontal position (n=200) by simple random method. Dry hot application (n1=50 experimental group) and non-steroidal antiinflammatory drug (NSAID) gel application (n2=50 control group) were performed to 100 patients who developed STP in the post-operative period. Pain assessment before and after the procedure was performed with Visual Analog Scale (VAS). Results: When the groups are examined according to the maternal position, it was found that the incidence of STP in the horizontal position (31.5%) was higher than the head up 400 position (18.5%) (p<0.03). STP was 76% in the right arm, 6% in the left arm, and 18% in both arms (p<0.001). It was found that women with local dry hot application to shoulder pain had lower VAS 2 pain scores (1.62±1.44) than the group with NSAI gel application (2.32±1.64) (p<0.05). Conclusion: When STP developed after cesarean section was examined according to the maternal position during surgery; the pain was found to be less in the head up 400 position than in the horizontal position. Local dry hot application was found to be more effective in reducing pain in the acute period compared to NSAID gel application in patients with STP after surgery.

Keywords: Shoulder type pain; cesarean section; anesthesia spinal
ÖZET
 Amaç: Spinal anestezi ile gerçekleştirilen sezaryen sırasındaki maternal baş yukarı pozisyonun post-operatif omuz tipi ağrı (OTA)ya etkisi ve tedavide farmakolojik olmayan yöntemlerin etkinliğini değerlendirmek amacıyla randomize kontrollü deneysel bir çalışma olarak planladık. Gereç ve Yöntemler: İstanbul'da Özel Nisa Hastanesi kadın doğum servisinde Şubat-Ağustos 2019 tarihleri arasında spinal anestezi ile sezaryen ameliyatı olacak 400 primipar gebe çalışmaya alındı. Katılımcılar basit rastgele yöntemle baş yukarı (n=200) ve yatay pozisyon (n=200) olmak üzere 2 gruba ayrıldı. Ameliyat sonrası dönemde OTA gelişen toplam 100 hastaya kuru sıcak uygulama (n1=50 deney grubu) ve non-steroidal anti-inflamatuar ilaç (NSAİİ) uygulama (n2=50 kontrol grubu) yapıldı. İşlem öncesi ve sonrası ağrı değerlendirme Görsel Kıyaslama Ölçeği (GKÖ) ile gerçekleştirildi. Bulgular: Gruplar maternal pozisyon şekline göre incelendiğinde; yatay pozisyonda OTA'nın görülme sıklığının (%31,5), baş 400 yukardaki pozisyona (%18,5) göre daha fazla olduğu saptanmıştır (p<0,03). OTA sağ kolda %76, sol kolda %6, her 2 kolda %18 oranında görülmektedir (p<0,001). Omuz ağrısına lokal kuru sıcak uygulama yapılan kadınların GKÖ 2 ağrı puan ortalamalarının (1,62±1,44), NSAİİ jel uygulaması yapılan gruba göre (2,32±1,64) daha düşük olduğu tespit edilmiştir (p<0,05). Sonuç: Sezaryen sonrası gelişen OTA ameliyat sırasındaki maternal pozisyon şekline göre incelendiğinde; ağrının baş 400 yukardaki pozisyonda yatay pozisyona göre daha az olduğu saptanmıştır. Ameliyat sonrası OTA gelişen hastalarda lokal kuru sıcak uygulamanın NSAİİ jel uygulamaya göre akut dönem ağrıyı azaltmada daha etkin olduğu tespit edilmiştir.

Anahtar Kelimeler: Omuz tipi ağrı; sezaryen; spinal anestezi
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