.: ORİJİNAL ARAŞTIRMA
COVID-19 Enfeksiyonunun Geriatrik Kalça Kırığı Olan Hastalarda Postoperatif Erken Dönem Ağrı Üzerine Etkisi: Retrospektif Kohort Çalışma
Effect of COVID-19 Infection on Postoperative Early-Period Pain in Patients with Geriatric Hip Fracture: Retrospective Cohort Study
Turkiye Klinikleri J Anest Reanim. 2022;20(2):64-71
doi: 10.5336/anesthe.2022-91658
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Kalça kırıkları; geriatrik hastalarda genellikle düşük enerjili travma sonucu oluşan, yaşlının tüm fizyolojisini ve yaşam kalitesini olumsuz etkileyerek yüksek mortalite oranları ile seyreden kendine özgü ciddi bir kırık çeşididir. Kliniği daha da komplike hâle getiren koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] pandemisinden etkilenen hastalarda ciddi ağrı oluşur ve kronik ağrı sendromuna neden olabilir. Bu çalışmanın amacı, kalça kırığı olan geriatrik hastalarda COVID-19 enfeksiyonunun ağrının nitelik ve niceliğine etkisini araştırmaktır. Gereç ve Yöntemler: Mart 2019-Mart 2020 tarihleri arasında Ankara Üniversitesi Tıp Fakültesi İbni Sina Hastanesinde, trokanterik kırık cerrahisi uygulanan 26 geriatrik hasta retrospektif olarak değerlendirildi. Hastalar, şiddetli akut solunum sendromu-koronavirüs-2 pozitif (Grup-C) ve negatif (Grup- N) olarak 2 gruba ayrıldı. Ameliyat sonrası ağrı, kısa McGill-Melzack ağrı soru formu (K-MASF) ve Vizüel Analog Skala (VAS) ile değerlendirildi. Hastalar ilk 12 ayda mortalite açısından takip edildi. Bulgular: Grup-C'de 10 hasta ve Grup-N'de 16 hasta değerlendirildi. Grup-C'de ortalama duyusal ağrı skoru 26,3±4,5 ve Grup-N'de 20±8,1 idi (p=0,01). Emosyonel ağrı şiddeti skoru Grup-C'de 9,3±2,0 ve Grup-N'de 6,1±2,8 idi (p=0,005). VAS ile ağrı şiddeti Grup-C'de 7,5±2,2 ve Grup-N'de 5±2,4 idi (p=0,01). On iki aylık takipteki mortalite oranı %26,9'du ve bu hastalarda K-MASF ve VAS skorları daha yüksekti (p<0,05). Sonuç: COVID-19 pozitif olan hastalarda ağrı niceliği ve niteliğinin, negatif olan hastalara göre daha yüksek olduğu görüldü. Postoperatif ağrıya bağlı komplikasyonları önlemek için standart analjezik tedaviler dışında etkili tedavi yöntemleri oluşturulmalıdır.
Anahtar Kelimeler: COVID-19; ağrı; geriatri; kalça kırıkları
Amaç: Kalça kırıkları; geriatrik hastalarda genellikle düşük enerjili travma sonucu oluşan, yaşlının tüm fizyolojisini ve yaşam kalitesini olumsuz etkileyerek yüksek mortalite oranları ile seyreden kendine özgü ciddi bir kırık çeşididir. Kliniği daha da komplike hâle getiren koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] pandemisinden etkilenen hastalarda ciddi ağrı oluşur ve kronik ağrı sendromuna neden olabilir. Bu çalışmanın amacı, kalça kırığı olan geriatrik hastalarda COVID-19 enfeksiyonunun ağrının nitelik ve niceliğine etkisini araştırmaktır. Gereç ve Yöntemler: Mart 2019-Mart 2020 tarihleri arasında Ankara Üniversitesi Tıp Fakültesi İbni Sina Hastanesinde, trokanterik kırık cerrahisi uygulanan 26 geriatrik hasta retrospektif olarak değerlendirildi. Hastalar, şiddetli akut solunum sendromu-koronavirüs-2 pozitif (Grup-C) ve negatif (Grup- N) olarak 2 gruba ayrıldı. Ameliyat sonrası ağrı, kısa McGill-Melzack ağrı soru formu (K-MASF) ve Vizüel Analog Skala (VAS) ile değerlendirildi. Hastalar ilk 12 ayda mortalite açısından takip edildi. Bulgular: Grup-C'de 10 hasta ve Grup-N'de 16 hasta değerlendirildi. Grup-C'de ortalama duyusal ağrı skoru 26,3±4,5 ve Grup-N'de 20±8,1 idi (p=0,01). Emosyonel ağrı şiddeti skoru Grup-C'de 9,3±2,0 ve Grup-N'de 6,1±2,8 idi (p=0,005). VAS ile ağrı şiddeti Grup-C'de 7,5±2,2 ve Grup-N'de 5±2,4 idi (p=0,01). On iki aylık takipteki mortalite oranı %26,9'du ve bu hastalarda K-MASF ve VAS skorları daha yüksekti (p<0,05). Sonuç: COVID-19 pozitif olan hastalarda ağrı niceliği ve niteliğinin, negatif olan hastalara göre daha yüksek olduğu görüldü. Postoperatif ağrıya bağlı komplikasyonları önlemek için standart analjezik tedaviler dışında etkili tedavi yöntemleri oluşturulmalıdır.
Anahtar Kelimeler: COVID-19; ağrı; geriatri; kalça kırıkları
ABSTRACT
Objective: Hip fractures are a unique serious fracture type that usually occurs as a result of low-energy trauma in geriatric patients, adversely affects the entire physiology and quality of life of the elderly and progresses with high mortality rates. In patients affected by the coronavirus disease-2019 (COVID-19) pandemic, which further complicated the clinic, severe pain occurs and can cause chronic pain syndrome. The aim of this study was to investigate the effect of COVID-19 infection on the quality and quantity of pain in geriatric patients with hip fractures. Material and Methods: Twenty-six geriatric patients undergoing trochanteric fracture surgery between March 2019 and March 2020 at Ankara University Faculty of Medicine İbni Sina Hospital were evaluated retrospectively. Patients were divided into 2 groups as severe acute respiratory syndrome-coronavirus-2 positive (Group-C) and negative (Group-N). Postoperative pain was evaluated with Short-form McGill pain questionnaire (SF-MPQ), and Visual Analog Scale (VAS). Patients were followed up in terms of mortality in the first 12 months. Results: Ten patients in Group-C and 16 patients in Group- N were evaluated. The mean sensory pain score was 26.3±4.5 in Group-C and 20±8.1 in Group-N (p=0.01). The emotional pain intensity score was 9.3±2.0 in Group-C and 6.1±2.8 in Group-N (p=0.005). VAS was 7.5±2.2 in Group-C and 5±2.4 in Group-N (p=0.01). The mortality rate was 26.9% at 12-month follow-up and the SF-MPQ and VAS scores of these patients were higher (p<0.05). Conclusion: The quantity and quality of pain was higher in patients who were positive for COVID-19 than in patients who were negative. In order to prevent complications related to postoperative pain, effective treatment methods other than standard analgesic therapies should be established.
Keywords: COVID-19; pain; geriatrics; hip fractures
Objective: Hip fractures are a unique serious fracture type that usually occurs as a result of low-energy trauma in geriatric patients, adversely affects the entire physiology and quality of life of the elderly and progresses with high mortality rates. In patients affected by the coronavirus disease-2019 (COVID-19) pandemic, which further complicated the clinic, severe pain occurs and can cause chronic pain syndrome. The aim of this study was to investigate the effect of COVID-19 infection on the quality and quantity of pain in geriatric patients with hip fractures. Material and Methods: Twenty-six geriatric patients undergoing trochanteric fracture surgery between March 2019 and March 2020 at Ankara University Faculty of Medicine İbni Sina Hospital were evaluated retrospectively. Patients were divided into 2 groups as severe acute respiratory syndrome-coronavirus-2 positive (Group-C) and negative (Group-N). Postoperative pain was evaluated with Short-form McGill pain questionnaire (SF-MPQ), and Visual Analog Scale (VAS). Patients were followed up in terms of mortality in the first 12 months. Results: Ten patients in Group-C and 16 patients in Group- N were evaluated. The mean sensory pain score was 26.3±4.5 in Group-C and 20±8.1 in Group-N (p=0.01). The emotional pain intensity score was 9.3±2.0 in Group-C and 6.1±2.8 in Group-N (p=0.005). VAS was 7.5±2.2 in Group-C and 5±2.4 in Group-N (p=0.01). The mortality rate was 26.9% at 12-month follow-up and the SF-MPQ and VAS scores of these patients were higher (p<0.05). Conclusion: The quantity and quality of pain was higher in patients who were positive for COVID-19 than in patients who were negative. In order to prevent complications related to postoperative pain, effective treatment methods other than standard analgesic therapies should be established.
Keywords: COVID-19; pain; geriatrics; hip fractures
REFERANSLAR:
- Pesante-Pinto JL. Clinical pharmacology and the risks of polypharmacy in the geriatric patient. Phys Med Rehabil Clin N Am. 2017;28(4):739-46. [Crossref] [PubMed]
- Deiner S, Silverstein JH, Abrams KJ. Management of trauma in the geriatric patient. Curr Opin Anaesthesiol. 2004;17(2):165-70. [Crossref] [PubMed]
- Gioffrè-Florio M, Murabito LM, Visalli C, Pergolizzi FP, Famà F. Trauma in elderly patients: a study of prevalence, comorbidities and gender differences. G Chir. 2018;39(1):35-40. [Crossref] [PubMed] [PMC]
- Zanker J, Duque G. Rapid geriatric assessment of hip fracture. Clin Geriatr Med. 2017;33(3):369-82. [Crossref] [PubMed]
- Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Pe-a M, Alonso-Blas C, et al. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019;14(1):203. [Crossref] [PubMed] [PMC]
- Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407-13. [Crossref] [PubMed]
- The management of chronic pain in older persons: AGS Panel on Chronic Pain in Older Persons. American Geriatrics Society. J Am Geriatr Soc. 1998;46(5):635-51. [Crossref] [PubMed]
- Biz C, Fantoni I, Crepaldi N, Zonta F, Buffon L, Corradin M, et al. Clinical practice and nursing management of pre-operative skin or skeletal traction for hip fractures in elderly patients: a cross-sectional three-institution study. Int J Orthop Trauma Nurs. 2019;32:32-40. [Crossref] [PubMed]
- Liu B, Li M, Zhou Z, Guan X, Xiang Y. Can we use interleukin-6 (IL-6) blockade for coronavirus disease 2019 (COVID-19)-induced cytokine release syndrome (CRS)? J Autoimmun. 2020;111:102452. [Crossref] [PubMed] [PMC]
- Fletcher D, Stamer UM, Pogatzki-Zahn E, Zaslansky R, Tanase NV, Perruchoud C, et al; euCPSP group for the Clinical Trial Network group of the European Society of Anaesthesiology. Chronic postsurgical pain in Europe: an observational study. Eur J Anaesthesiol. 2015;32(10):725-34. [Crossref] [PubMed]
- Michaelides A, Zis P. Depression, anxiety and acute pain: links and management challenges. Postgrad Med. 2019;131(7):438-44. [Crossref] [PubMed]
- Boureau F, Luu M, Doubrere JF, Gay C. [Construction of a questionnaire for the self-evaluation of pain using a list of qualifiers. Comparison with Melzack's McGill Pain Questionnaire]. Therapie. 1984;39(2):119-29. [PubMed]
- Feldt KS, Oh HL. Pain and hip fracture outcomes for older adults. Orthop Nurs. 2000;19(6):35-44. [Crossref] [PubMed]
- Morrison SR, Magaziner J, McLaughlin MA, Orosz G, Silberzweig SB, Koval KJ, et al. The impact of post-operative pain on outcomes following hip fracture. Pain. 2003;103(3):303-11. [Crossref] [PubMed]
- Rajan J, Behrends M. Acute pain in older adults: recommendations for assessment and treatment. Anesthesiol Clin. 2019;37(3):507-20. [Crossref] [PubMed]
- Small C, Laycock H. Acute postoperative pain management. Br J Surg. 2020;107(2):e70-e80. [Crossref] [PubMed]
- Nishizawa Y, Hata T, Takemasa I, Yamasaki M, Akasaka H, Sugimoto K, et al. Clinical benefits of single-incision laparoscopic surgery for postoperative delirium in elderly colon cancer patients. Surg Endosc. 2018;32(3):1434-40. [Crossref] [PubMed]
- Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101(1):77-86. [Crossref] [PubMed]
- Glare P, Aubrey KR, Myles PS. Transition from acute to chronic pain after surgery. Lancet. 2019;393(10180):1537-46. [Crossref] [PubMed]
- Labò N, Ohnuki H, Tosato G. Vasculopathy and coagulopathy associated with SARS-CoV-2 infection. cells. 2020;9(7):1583. [Crossref] [PubMed] [PMC]
- Mondal R, Lahiri D, Deb S, Bandyopadhyay D, Shome G, Sarkar S, et al. COVID-19: are we dealing with a multisystem vasculopathy in disguise of a viral infection? J Thromb Thrombolysis. 2020;50(3):567-79. [Crossref] [PubMed] [PMC]
- White SM, Rashid N, Chakladar A. An analysis of renal dysfunction in 1511 patients with fractured neck of femur: the implications for peri- operative analgesia. Anaesthesia. 2009;64(10):1061-5. [Crossref] [PubMed]
- Micallef J, Soeiro T, Jonville-Béra AP; French Society of Pharmacology, Therapeutics (SFPT). Non-steroidal anti-inflammatory drugs, pharmacology, and COVID-19 infection. Therapie. 2020;75(4):355-62. [Crossref] [PubMed] [PMC]
- Rinott E, Kozer E, Shapira Y, Bar-Haim A, Youngster I. Ibuprofen use and clinical outcomes in COVID-19 patients. Clin Microbiol Infect. 2020;26(9):1259.e5-e7. [Crossref] [PubMed] [PMC]
- Kathirgamanathan A, Douglas MJ, Tyler J, Saran S, Gunka V, Preston R, et al. Speed of spinal vs general anaesthesia for category-1 caesarean section: a simulation and clinical observation-based study. Anaesthesia. 2013;68(7):753-9. [Crossref] [PubMed]
- Varandas JS, Dias R, Mendes AB, Lages N, Machado H. New indication for an old anesthetic technique: could we consider now rapid sequence spinal anesthesia in a COVID-19 time? Reg Anesth Pain Med. 2021;46(2):191. [Crossref] [PubMed] [PMC]
- Berninger MT, Friederichs J, Leidinger W, Augat P, Bühren V, Fulghum C, et al. Effect of local infiltration analgesia, peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in total knee arthroplasty. BMC Musculoskelet Disord. 2018;19(1):232. [Crossref] [PubMed] [PMC]
- Guay J, Kopp S. Peripheral nerve blocks for hip fractures in adults. Cochrane Database Syst Rev. 2020;11(11):CD001159. [PubMed] [PMC]
- Resch S, Thorngren KG. Preoperative traction for hip fracture: a randomized comparison between skin and skeletal traction in 78 patients. Acta Orthop Scand. 1998;69(3):277-9. [Crossref] [PubMed]
- Elboim-Gabyzon M, Andrawus Najjar S, Shtarker H. Effects of transcutaneous electrical nerve stimulation (TENS) on acute postoperative pain intensity and mobility after hip fracture: a double-blinded, randomized trial. Clin Interv Aging. 2019;14:1841-50. [Crossref] [PubMed] [PMC]
- Romero Pisonero E, Mora Fernández J. [Multidisciplinary geriatric rehabilitation in the patient with hip fracture and dementia]. Rev Esp Geriatr Gerontol. 2019;54(4):220-9. [Crossref] [PubMed]
- Ojeda-Thies C, Cuarental-García J, García-Gómez E, Salazar-Zamorano CH, Alberti-Maro-o J, Ramos-Pascua LR. Hip fracture care and mortality among patients treated in dedicated COVID-19 and non-COVID-19 circuits. Eur Geriatr Med. 2021;12(4):749-57. [Crossref] [PubMed] [PMC]
- Holmberg T, Davidsen M, Thygesen LC, Krøll MJ, Tolstrup JS. Mortality among persons experiencing musculoskeletal pain: a prospective study among Danish men and women. BMC Musculoskelet Disord. 2020;21(1):666. [Crossref] [PubMed] [PMC]
.: İşlem Listesi