ABSTRAK
Latar Belakang : Nyeri paska bedah seksio sesaria merupakan masalah utama
karena apabila nyeri tidak diatasi akan menimbulkan dampak negatif dan akhirnya
akan mempengaruhi kualitas perawatan bayi oleh ibunya. Opioid merupakan pilihan
utama untuk terapi nyeri paska pembedahan, akan tetapi dibatasi oleh efek
sampingnya seperti depresi pernafasan, sedasi, mual muntah, dan pruritus. Sehingga
sekarang banyak digunakan obat anti inflamasi nonsteroid (AINS) sebagai pengganti
opioid, namun pemberian AINS memiliki efek samping seperti peningkatan waktu
perdarahan, luka pada organ gastrointestinal, dispepsia, gangguan ginjal, mual, nyeri
kepala, somnolen, mengantuk, palpitasi dan pruritus. Karena pemberian AINS juga
dapat menimbulkan resiko yang merugikan pasien, maka digunakan parasetamol
karena selain aman digunakan, efek samping minimal, ditoleransi dengan baik, juga
memiliki kekuatan analgesia untuk penanganan nyeri paska pembedahan tingkat
ringan, sedang maupun berat.
Metode : Penelitian dengan uji klinis acak terkontrol, tersamar ganda. Lima puluh
pasien ASA 1 – 2, usia 20 – 30 tahun yang akan menjalani operasi emergensi seksio
sesaria dengan anestesi regional blok subaraknoid, di acak untuk menentukan
analgetik pasaka pembedahan kelompok I (parasetamol 1 gr/6 jam) atau kelompok II
(ketorolak 30 mg/ 6 jam). Pada kedua kelompok dibandingkan nilai VAS pada saat
istirahat dan bergerak, efek samping serta kebutuhan analgetik tambahan paska
pembedahan pada jam ke 0, 1, 2, 3, 4, 6, 9, 12, 18 dan 24.
Universitas Sumatera Utara
Hasil : Hasil penelitian evaluasi nyeri paska bedah dengan Visual Analogue Scale
didapati nilai VAS saat istirahat adanya perbedaan tidak bermakna pada jam ke 1
(p = 0.08), jam ke 2 (p = 0.42), jam ke 4 (p = 0.56), jam ke 6 (p = 0.06), jam ke 18 (p
= 1.00) dan jam ke 24 (p = 0.71) paska operasi serta juga didapatkan hasil adanya
perbedaan yang bermakna pada jam ke 3 (p = 0.02), jam ke 9 (p < 0.01) dan jam ke
12 (p = 0.02) paska operasi di kedua kelompok. Dan nilai VAS saat bergerak di
kedua kelompok didapatkan hasil adanya perbedaan tidak bermakna pada jam
1 (p = 0.06), jam ke 2 (p = 0.90), jam ke 4 (p = 0.11), jam ke 6 (p = 0.07), jam ke 9 (p
= 0.56) dan jam ke 24 (p = 0.62) paska operasi serta juga didapatkan hasil adanya
perbedaan yang bermakna pada jam ke 3 (p = 0.03), jam ke 12 (p = 0.04) dan jam ke
18 (p = 0.02) paska operasi. Pemberian ketorolak menimbulkan rasa mual sedangkan
pemberian parasetamol tidak menimbulkan rasa mual, namun secara statistik kedua
hal ini dinyatakan berbeda tidak bermakna. Pemberian parasetamol atau ketorolak
juga sama-sama membutuhkan analgetik tambahan untuk mencapai nilai VAS 1 – 4
dan secara statistik kedua kelompok dinyatakan berbeda tidak bermakna.
Kesimpulan : Parasetamol dapat sebagai alternatif pengganti ketorolak untuk
mengatasi nyeri paska pembedahan seksio sesaria, karena memiliki efek analgetik
yang setara dengan ketorolak. Dan pemberian parasetamol dan ketorolak belum bisa
sebagai analgetik tunggal untuk penanganan nyeri paska pembedahan seksio sesaria.
Kata kunci : Parasetamol, Ketorolak, Visual Analogue Scale, Efek Samping,
Analgetik Tambahan
Universitas Sumatera Utara
ABSTRACT
Background : Post-surgical pain in cesarean section is a major problem because if
the pain is not addressed well it will cause a negative impact on post surgical patients
and ultimately affects the quality of infant care by his mother. Opioid therapy is the
main option for post-surgical pain, but the usage is limited due to the side effects
such as respiratory depression, sedation, nausea, vomiting, and pruritus. Nonsteroidal
anti-inflammatory drugs (NSAIDs) is now widely used as a substitute for opioids,
however giving NSAIDs also have side effects such as increased bleeding time,
injury to the gastrointestinal organs, dyspepsia, kidney disorders, nausea, headache,
somnolence, drowsiness, palpitations and pruritus. Because of the administration of
NSAIDs may also pose risks that can harm the patient, then paracetamol which is
safe to use, has minimal side effects, well tolerated, and also has the analgesia power
for post-surgical pain management mild, moderate or severe is now considered.
Methode : Research was done with randomized controlled clinical trials, doubleblind. Fifty patients, ASA 1-2, aged 20-30 years, that underwent emergency surgery
cesarean section with subarachnoid block regional anesthesia, was randomly divided
to determine the analgesia post surgery in group I (paracetamol 1 g / 6 h) or group II
(30 mg ketorolac / 6 hours). VAS values in both groups were compared at resting
position and while moving, side effects and additional analgesia requirements after
surgery were also noted at 0, 1st, 2nd, 3rd, 4th, 6th, 9th, 12th, 18th and 24th hour post
surgery.
Universitas Sumatera Utara
Result : The results of post-surgical pain evaluation by Visual Analogue Scale VAS
values found at resting position have no significant difference at the 1st hour
(p=0:08), 2nd hour (p=0:42), 4th hour (p=0:56), 6th hour (p=0.06), 18th hour (p=1.00)
and 24th hour (p=0.71) post-surgery, as well as the results obtained that have
significant differences were at the 3rd hour (p=0.02), 9th hour (p<0.01 ) and the 12th
hour (p=0.02) post surgery in both groups. VAS values while moving in both groups
have no significant difference at 1st hour (p=0.06), 2nd hour (p=0.90), 4th hour
(p=0.11), 6th hour (p=0.07), 9th hour (p=0:56) and 24th hour (p=0.62) post-surgery,
while the results obtained that have significant differences was found at the 3rd hour
(p=0.03), 12th hour (p=0.04), 18th hour (p=0.02) post surgery. Administration of
ketorolac could cause nausea while paracetamol did not, but statistically the
difference from both of these groups proved meaningless. Giving paracetamol or
ketorolac equally requires additional analgesias to achieve VAS value 1-4 and the
two groups were statistically found to have no significant difference.
Conclusion: Paracetamol can be used as an alternative drug to ketorolac in order to
overcome post-surgical pain cesarean section, because it has an equivalent analgesia
effect as ketorolac. Administration of paracetamol and ketorolac can not be used as a
single drug therapy for pain management in post caesarean section.
Keywords : Parasetamol, Ketorolac, Visual Analogue Scale, Side effect,
Additional analgesia
Universitas Sumatera Utara