Publication: Temporomandibular eklem artoskopisinde intraartiküler ketaminin postoperatif ağrı üzerine etkisi
Abstract
TEMPOROMANDĠBULAR EKLEM ARTROSKOPĠSĠNDE ĠNTRAARTĠKÜLER KETAMĠNĠN POSTOPERATĠF AĞRI ÜZERĠNE ETKĠSĠ Temporomandibular eklem (TME) rahatsızlıkları, hastaların ciddi ağrı duymalarına ve fonksiyon kaybına neden olur (87). Birçok cerrah konservatif yöntemlerle tedavi edilemeyen eklem rahatsızlıklarında, morbidite ve çalışma zamanının daha kısa olmasından dolayı artroskopiyi tercih etmektedir (25). Diagnostik değerine ek olarak artroskopinin terapötik değeri de bulunmaktadır. Artroskopik işlem, genellikle fizyolojik salinle, eklemin superior boşluğunun lavajını takiben kör trokarla fibrotik adezyonların lizisini içerir (17, 25, 55, 85, 115). Cerrahi işlem sırasında, C liflerinde sürekli stimülasyon oluşturan ağrılı uyaranlar, dorsal boynuzdaki nöronlarda aktivite artışına neden olur. Bunun sonucunda santral sensitizasyon ve hiperaljezi gelişir (67). TME artroskopisi sonrası, postoperatif ağrının kontrolü için uzun etkili lokal anestezikler (bupivakain) ve opioidler (morfin) kullanılmıştır (15, 21, 34, 94). Ketamin, postoperatif ağrının önlenmesinde intraartiküler olarak diz artroskopilerinden sonra kullanılmıştır (15, 21, 94). Ketamin, 30 yıldır kullanılan, en az kardiyovasküler depresan etkisi olan, analjezik ve lokal anestezik özellikleri olan tek anestezik ajandır. Daha önceki çalışmalarda ketaminin ağrı üzerinde periferik etkisi olduğu bildirilmiştir. Ketaminin periferik analjezik etkisinin temeli periferik sensör aksonlardaki N-Metil-D-Aspartat’ın (NMDA) iyonotropik glutamat reseptörünün varlığına dayanır. Ketamin, NMDA reseptör aktivasyonunu bloke eder (9, 15, 21). Bu çalışmanın amacı, TME artroskopisinden sonra postoperatif ağrının önlenmesinde intraartiküler ketaminin analjezik etkisini araştırmaktır. TME, artroskopi, ketamin, postoperatif ağrı 2 2.
POSTOPERATIVE ANALGESIA AFFECT OF INTRA ARTICULAR KETAMINE ADMINISTRATION AFTER TMJ ARTHROSCOPY Temporomandibular joint disorders cause severe pain and function release (87). Several surgeons prefer arthroscopy for temporomandibular joint disorders which can not be treat with conservative methods, because of less morbidity and short working time (25). TMJ arthroscopy is used in diagnosis and treatment of pain at this region. As the arthroscopy is valuable for diagnosis, it has also therapautic affects. The steps of arthroscopic technique are, the irrigation of the superior fossa of the TMJ with saline solution, then lysis of fibrotic adhesions with blind trocar and manipulation of the mandibula (17, 25, 55, 85,115). In response to repeated painful stimuli generated by repetitive stimulation of C fibers, the dorsal horn neurons engage in progresively increased activity postoperatively (67). Local anaesthesics (bupivacaine) which have long half life and opioids (morfin) were used for postoperative pain control after the TMJ arthroscopy (15, 21, 34, 94). Following the knee arthroscopies intra-articular ketamine injection has been used for controling the pain (15, 21, 94). Ketamine has been used for 30 years. It has analgesic, local anaesthesic and less cardiovascular depresant affect. Previous studies showed that ketamine has analgesic affects on peripheric pain. The bases of the peripheric analgesic affect of ketamin depends on the peripheric NMDA ionotropic receptor of the glutamate. Ketamine blocks the activation of the NMDA receptor (9, 15, 21). The aim of this study is the evaluation of the analgesic affect of intra-articular ketamine injection on postoperative pain following the TMJ arthroscopy. Key Words: TMJ, arthroscopy, ketamine, postoperative pain
POSTOPERATIVE ANALGESIA AFFECT OF INTRA ARTICULAR KETAMINE ADMINISTRATION AFTER TMJ ARTHROSCOPY Temporomandibular joint disorders cause severe pain and function release (87). Several surgeons prefer arthroscopy for temporomandibular joint disorders which can not be treat with conservative methods, because of less morbidity and short working time (25). TMJ arthroscopy is used in diagnosis and treatment of pain at this region. As the arthroscopy is valuable for diagnosis, it has also therapautic affects. The steps of arthroscopic technique are, the irrigation of the superior fossa of the TMJ with saline solution, then lysis of fibrotic adhesions with blind trocar and manipulation of the mandibula (17, 25, 55, 85,115). In response to repeated painful stimuli generated by repetitive stimulation of C fibers, the dorsal horn neurons engage in progresively increased activity postoperatively (67). Local anaesthesics (bupivacaine) which have long half life and opioids (morfin) were used for postoperative pain control after the TMJ arthroscopy (15, 21, 34, 94). Following the knee arthroscopies intra-articular ketamine injection has been used for controling the pain (15, 21, 94). Ketamine has been used for 30 years. It has analgesic, local anaesthesic and less cardiovascular depresant affect. Previous studies showed that ketamine has analgesic affects on peripheric pain. The bases of the peripheric analgesic affect of ketamin depends on the peripheric NMDA ionotropic receptor of the glutamate. Ketamine blocks the activation of the NMDA receptor (9, 15, 21). The aim of this study is the evaluation of the analgesic affect of intra-articular ketamine injection on postoperative pain following the TMJ arthroscopy. Key Words: TMJ, arthroscopy, ketamine, postoperative pain