Meme Kanserinde Postoperatif Ağrı ve Yönetimi
Özet
Meme kanseri tedavisindeki gelişmeler sağkalım oranlarını artırmış, ancak hastaların yaşam kalitesini olumsuz etkileyen postoperatif kronik ağrı tablosunu ön plana çıkarmıştır. Meme cerrahisi geçiren hastaların yaklaşık %60’ı akut dönemde şiddetli ağrı yaşarken, %11-57’sinde bu durum 3 aydan uzun sürerek kronikleşmektedir. Genç yaş, obezite, preoperatif ağrı, anksiyete/depresyon, cerrahi girişim büyüklüğü (özellikle aksiller lenf nodu diseksiyonu) ve adjuvan radyoterapi temel risk faktörleridir. Etiyolojide sinir hasarlarına bağlı nöropatik ağrılar baskındır. Aksiller diseksiyonlarda yüksek oranda yaralanan interkostabrakial sinir hasarları, T3-T6 interkostal sinir harabiyeti sonucu oluşan interkostal deri nöromaları ve merkezi sinir sistemi değişikliklerinden kaynaklanan hayalet (fantom) ağrısı sıklıkla görülmektedir. Ayrıca motor sinir hasarları kas-iskelet ağrılarını tetikleyebilir. Kronikleşmeyi önlemek için akut dönemin erken ve agresif multimodal analjezi ile yönetimi şarttır. Tedavide basamaklı farmakolojik ajanlar (gabapentinoidler, antidepresanlar, opioidler), fizik tedavi, psikolojik destek ve ultrasonografi eşliğinde uygulanan girişimsel yöntemler multidisipliner bir yaklaşımla kullanılmaktadır.
Advances in breast cancer treatment have increased survival rates, but have also highlighted the issue of postoperative chronic pain, which negatively impacts patients' quality of life. Approximately 60% of patients undergoing breast surgery experience severe pain in the acute phase, and in 11-57% of these cases, this pain persists for more than 3 months, becoming chronic. Young age, obesity, preoperative pain, anxiety/depression, the size of the surgical procedure (especially axillary lymph node dissection), and adjuvant radiotherapy are key risk factors. Neuropathic pain due to nerve damage is the predominant etiology. Intercostobrachial nerve damage, which is highly prevalent in axillary dissections, intercostal skin neuromas resulting from T3-T6 intercostal nerve damage, and phantom pain stemming from central nervous system changes are frequently observed. Furthermore, motor nerve damage can trigger musculoskeletal pain. Early and aggressive multimodal analgesia management of the acute phase is essential to prevent chronicity. Treatment involves a multidisciplinary approach using a range of pharmacological agents (gabapentinoids, antidepressants, opioids), physical therapy, psychological support, and interventional methods guided by ultrasonography.
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