<![CDATA[Nyeri pascaoperasi adalah masalah penting dalam pembedahan. Studi terbaru menyatakan bahwa pemberiananalgesik perioperatif dapat mencegah serta mengurangi nyeri pascaoperasi. Studi ini bertujuan untuk menjelaskanefek analgesik preemtif dalam penanganan nyeri pascaoperasi laparatomi ginekologi. Jenis penelitian ini adalahprospektif, uji acak terkontrol buta ganda dan uji plasebo-kontrol, dimana 46 pasien dengan American SocietyAssociation (ASA) I dan II yang menjalani operasi laparatomi ginekologi secara acak di central operating theatre(COT), RS. Dr. Hasan Sadikin pada September sampai Desember 2012 diberikan 50 mL bupivakain 0,25% denganepinefrin 5μ per mL atau 50 mL normal salin; setiap 25 mL nya dimasukkan ke dalam rongga peritoneum daninfiltrasi kulit. Skor nyeri pasien dievaluasi dengan sistem Visual Analog Scale (VAS) saat diam dan mobilisasi,dinilai 6 jam pertama, lalu dilanjutkan jam ke- 8,12 dan 24 pascaoperasi. Dihitung jumlah pemakaian analgesikpertolongan selama 24 jam pertama. Hasil penelitian menunjukkan bahwa nyeri saat mobilisasi grup plasebo (P)lebih tinggi dibandingkan dengan grup bupivakain (B). Skor nyeri grup P secara signifikan lebih tinggi daripadagrup B saat mobilisasi (p<0,05). Kombinasi bupivakain secara intraperitoneum dan infiltrasi kulit akhir operasilaparatomi ginekologi dapat mengurangi nyeri pascaoperasi saat mobilisasi.
Kata kunci: Bupivakain, intraperitoneum, nilai skala analog visual, nyeri pascaoperasi.
Postoperative pain is an important surgical problem. Recent studies shows that perioperative administration ofanalgesics may be possible to prevent or reduce postoperative pain. This study was planned to investigate theefficacy of pre-emptive analgesia on postoperative pain after major gynecologic abdominal surgeries. In thisprospective, double-blinded, randomized, and placebo-controlled trial, 46 ASA physical status I and II patientsundergoing major abdominal gynecologic surgeries were randomized to receive 50 mL of bupivacaine 0.25% withepinephrine 5μ per mL or 50mL of normal saline; each 25 mL of the treatment solution was administered into theperitoneal cavity and incision. The pain score of the patients was evaluated by the visual analogue scale (VAS) atrest and movement, and every hours untill 6h, 8, 12, and 24h after surgery. Pain on movement was significantlymore intense in the Placebo group than in the Bupivacaine group. Measurement of the quality of pain by using theVAS values during mobilization is better than at rest. Pain scores were significantly higher in the placebo groupthan in the bupivacaine group on movement (p<0.05). A combination of intraperitoneal and incisional bupivacaineinfiltration at the end of abdominal gynecologic surgeries reduces postoperative pain on movement.
Keywords: Bupivacaine, intraperitoneal, postoperative pain, visual analog scale.
Reference
Macres SM, Moore PG, Fishman SM. Acute Pain Management. Dalam: Barash PG, Cullen BF, Soelting RK, editor. Clinical Anesthesia. Edisi ke-6. Philadelphia: Lippincot William & Wilkins 2009. hlm.1405–40.
Tsui BC, Rosenquist RW. Peripheral Nerve Blockade. Dalam: Barash PG, Cullen BF, Soelting RK, editor. Clinical Anesthesia. Edisi ke-6. Philadelphia: Lippincot William & Wilkins 2009. hlm. 718–45.
Rukewe A, Fatiregun A. The use of regional anesthesia by anesthesiologists in Nigeria. Anesth Analg 2010;110:234–4.
Atashkhoii S, Shobeiri MJ, Azarfarin R. Intraperitoneal and incisional bupivacaine analgesia for major abdominal/gynecologic surgery: a placebo-controlled trial. Iran: Medical Journal of The Islamic Republic of Iran 2006;20(1):19–22.
Visalyaputra S, Lertakyamanee J, Pethpaisit N, Somprakit P, Parakkamodom S, Suwanapeum P. Intraperitoneal lidocaine decreases intraoperative pain during postpartum tubal ligation. Anesth Analg. 1999;88:1077–88.
Ng A, Smith G. Intraperitoneal administration of analgesia: is this practice of any utility? Br J Anaesth 2002;4:535–7.
Simpson RB, Russell D. Anesthesia for daycase gynaecological laparoscopy: a survey of clinical practice in the United Kingdom. Anesthesia 1999;54:72–80.
Groudine SB, Fisher HAG, Kaufman RP, Patel MK, Wilkins LJ, Mehta SA, et al. Intravenous lidocain speeds the return of bowel function, decrease postoperative pain and shorters hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg 1998;86:235–9.
Moiniche S, Jorgensen H, Wetterslev J, Berg J. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg 2000; 90:899–912.
Williamson KM, Cotton BR, Smith G. Intraperitoneal lignocaine for pain relief after total abdominal hysterectomy. Br J Anaesth 1997;78:675–7.
Ali PB, Cotton BR, Williamson KM, Smith G. Intraperitoneal bupivacaine or lidocaine does not provide analgesia after total abdominal hysterectomy. Br J Anaesth 1998;80:245–7.
Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E. Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebocontrolled comparison of bupivacaine and ropivacaine. Anesth Analg 2000;91:403–7.
Ng A, Swami A, Smith G, Davidson AC, Emembolu J. The analgesic effects of intraperitoneal and incisional bupivacaine with epinephrine following total abdominal hysterectomy. Anesth Analg 2002;95:158–62.
Morgan GE, Mikhail MS, Murray MJ. Pain Management. Dalam: Morgan GE, Mikhail MS, Murray MJ, editor. Clinical anesthesiology. Edisi ke-4. New York: McGraw-Hill;2006. hlm. 360–72.
Lou L, Sabar R, Kaye AD. Local Anesthetics. Dalam : Raj PP. Textbook of Regional Anesthesia. Edisi ke-3. Philadelphia. Churchill Livingstone. 2002. hlm. 214–53
Hannibal K, Galatius H, Hansen A, Obel E, et al. Preoperative wound infiltration with bupivacaine reduces early and late opioid requirement after hysterectomy. Anesth Analg. 1996;83:376–81
]]>
Copyrights © 2016
