Pós-operatório tardio de descompressão neural periférica em hanseníase: desfecho clínico e percepção do paciente

Abstract

Introduction: There is no consensus about the surgical treatment of the leprous neuritis, opening up a gap for evaluation of the clinical outcome especially when it comes to long-term studies. Objective: This study aimed to evaluate individuals who were in the late postoperative period (equal 1 year or over) of surgical decompression of peripheral nerves, as the neural function, prevalence and pain intensity, prednisone dose and patients' perception. Method: Patients who had surgery in the period 2010 between 2014 were assessed, identified in the institutional database , and evaluated in three periods : preoperative ( PrO ) and postoperative 180 days ( PO180 ) , where data were obtained of medical records ; and late postoperative ( LPO) , where evaluation was performed in patients recruited by letter and / or telephone to attend the service. To evaluate the LPO, the following instruments were used: socioeconomic and clinical questionnaire, simplified neurological evaluation, visual analogue pain scale, DN4 questionnaire and Salsa scale.. Results: 90 individuals who had surgery on LPO (equal 1 year or over) were assessed: 65,6% were men, with predominance of multibacillary shapes (78,9%) and borderline group (76,7%). The surgical approach was taken by limb, 246 nerves were operated: 71 median and ulnar nerves; 52 tibial and peroneal nerves. There was a significant improvement of the motor function in the operated nerves (p<0,05), except in the left fibular one. In relation to sensibility, there was an improvement in the right peroneal and tibial nerves (p<0, 05), while the ulnar sensitivity improved between PrO and LPO (p < 0,05). In 20% of the cases there was an overall remission of pain (p<0,001), significant reduction of the intensity in 52,2% (47/90), and 41,1% (37/90) filled the criteria of neuropathic pain. Out of the individuals who used corticoids, 80% stopped using them. 87,7% of the patients had a favorable perception to the outcome of the surgery. On Scale Salsa, 66 % of the subjects had mild limitation or limitation of absence. Conclusion: The absence of a significant improvement in sensitivity and improved motor function in the LPO showed that the indications of surgery may have been delayed because the involvement of sensitivity in leprosy generally precedes the motor loss, therefore, these sensory fibers undergo a prolonged injury time or these fibers have greater difficulty in regeneration. The PO180 was insufficient to assess the outcome of surgery, especially for the sensitivity of the ulnar nerve. LPO, the results. They showed besides the improvement of motor skills, decrease of the frequency and the intensity of pain, reducing the use of corticosteroids, and consequently greater patient satisfaction with surgery. This study reinforces the need of an early and adequate indication of the surgical decompression peripheral nerves in leprosy as a complementary procedure in the treatment of neuritis and a strategy of prevention of incapacities