Darmawan, Haris and dr. Ristiawan Muji L., SpAn KMN and dr. Isngadi, , Mkes, SpAn, KAO (2018) Perbandingan Efek Analgesia Adductor Canal Block Dengan Analgesik Intravena Sebagai Tata Laksana Nyeri Multimodal Pada Post Operasi Rekonstruksi Ligamentum Cruciatum Anterior. Magister thesis, Universitas Brawijaya.
Abstract
Pendahuluan : Nyeri pasca operasi merupakan komplikasi bermakna pada sebagian besar pasien. Penanganan nyeri yang tidak adekuat dapat menimbulkan penderitaan dan ketidaknyamanan serta berbagai konsekuensi psikologis dan fisiologis hingga timbulnya nyeri kronik. Rekonstruksi ligamentum cruciatum anterior (LCA) merupakan prosedur yang umum dikerjakan pada pasien usia dewasa muda. Penanganan nyeri yang baik dapat mempercepat mobilisasi dan rehabilitasi. Penanganan nyeri secara multimodal memiliki efek yang signifikan karena digunakan lebih dari satu modalitas terapi yang bekerja pada dua jalur berbeda dari jaras nyeri. Berbagai modalitas tata laksana nyeri pada pasca rekonstruksi LCA sudah dikembangkan di dunia. Peran blok saraf perifer, yakni adductor canal block (ACB) dapat digunakan karena efek blok infrapatellar. ACB dapat mengurangi penggunaan opioid pasca operasi dengan skala nyeri yang lebih baik. Namun bukti penelitian masih belum banyak dipublikasikan. Metode : Studi retrospektif analitik deskriptif dilakukan dengan cara menelusuri data rekam medis pasien yang dikerjakan rekonstruksi LCA sejak bulan mei 2018 di Rumah Sakit Saiful Anwar Malang. Data rekam medis yang ditelusuri berdasarkan kriteria inklusi : pasien berusia 15-60 tahun, status fisik asa 1-2, body mass index 18,5-24,9 kg/m2, pasien telah menjalani operasi rekonstruksi LCA dengan subarachnoid block (SAB) dengan bupivakain hiperbarik dan pasca operasi mendapatkan satu diantara dua perlakuan, yakni ACB atau analgesik intravena tramadol, dan data rekam medis lengkap. Data rekam medis yang diambil adalah : NRS, penggunaan rescue dose, dan lama rawat inap. Hasil : Penelitian ini mengambil 30 sampel, dengan 15 sampel dengan pemberian ACB dan 15 sampel lainnya mendapatkan analgesik intravena. Uji komparasi NRS diam maupun gerak pada 6 jam, 12 jam, 24 jam, hari ke- 1, ke-2 pasca operasi menunjukkan rerata NRS pada perlakuan ACB lebih rendah daripada pemberian analgesia intravena. Pada pengamatan lama rawat inap dan penggunaan rescue dose, menunjukkan bahwa kedua perlakuan tidak berbeda signifikan. Kesimpulan : Ada perbedaan bermakna terhadap NRS pada pemberian ACB dibandingkan analgesik intravena, sedangkan untuk lama rawat inap dan pemberian rescue dose, kedua perlakuan tidak berbeda secara signifikan.
English Abstract
Introduction : Post operative pain has become significant complication for almost all patients. Inadequate pain management can be devastating and might give rise to chronic pain. Anterior cruciate ligament (ACL) reconstruction is a common procedure performed in young adult patients. Good pain management plays very important role in early mobilitation and rehabilitation. Multimodal pain management has an excellent outcome because it is involving more than one modality of therapy in which influence two different points in pain pathway. Various pain management medications and modalities after ACL reconstruction have been developed in the world. The role of peripheral nerve block, termed adductor canal block (ACB) can be used because of infrapatellar block provided. This technique may reduce the use of opioid post operatively with excellent pain score outcome. But, only few research has been published. Methods : A descriptive analytic retrospective study has been done by recording some patients medical record that performed ACL reconstruction in Saiful Anwar General Hospital, Malang, since may 2018. Inclusion criteria were patient 15-60 years of age, physical status ASA 1-2, body mass index 18,5-24,9 kg/m2, patient has undergone ACL reconstruction with subarachnoid block (SAB), patient treated with one of the two treatments : ACB or intravenous analgesic tramadol, and also complete medical record recording patients follow up. The datas extracted were : NRS, rescue dose administration, and length of hospitalization. Results : This study included 30 samples divided into two groups 15 samples received ACB and others received intravenous analgetics. Demographic data study showing that samples included were homogen. NRS comparative testing at 6 hours, 12 hours, 24 hours, day -1, day -2 for both treatments were showing that value NRS in patients with ACB lower than those with intravenous analgetics.The length of hospitalization and rescue dose administration, in both treatments showed that no significant differences. Conclusions : There were significant differences in NRS evaluation between two treatments, where ACB provided lower NRS outcome than intravenous analgetic. Meanwhile, for the length of hospital stay and rescue dose analgesic treatment both statistically insignificant.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/617.96/DAM/p/2018/041901968 |
| Uncontrolled Keywords: | Adductor canal block, rekonstruksi ligamentum cruciatum anterior, subarachnoid block, numeric rating scale,Adductor canal block, ACL reconstruction, subarachnoid block, numeric rating scale |
| Subjects: | 600 Technology (Applied sciences) > 617 Surgery, regional medicine, dentistry, ophthalmology, otology, audiology > 617.9 Operative surgery and special fields of surgery > 617.96 Anesthesiology |
| Divisions: | Profesi Kedokteran > Spesialis Anestesiologi dan Terapi Intensif, Fakultas Kedokteran |
| Depositing User: | soegeng sugeng |
| Date Deposited: | 16 Aug 2022 01:18 |
| Last Modified: | 16 Aug 2022 01:18 |
| URI: | http://repository.ub.ac.id/id/eprint/193241 |
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