EFEKTIFITAS KETAMIN SEBAGAI ANALGESIA PREEMPTIF TERHADAP NYERI PASKA BEDAH ONKOLOGI

Abstract

Latar belakang : Excitatory amino acids participate in the activation of nociceptive dorsal horn neurons as agonists of the N-methyl-D-aspartate (NMDA) receptor. A series of experimental data provides evidence that NMDA receptors play a significant role in neuronal plasticity and processes leading to central sensitization to pain. The concept of preemptive analgesia is based on the assumption that the administration of an analgesic drug before the occurrence of nociceptive input can prevent sensitization and thus improve postoperative analgesia. Purpose : The aim of our study was to test the hypothesis that preemptive ketamine administration would fiwther reduce postoperative pain in oncology surgery. Method : Our institutional review board approved the study protocol, and all patients gave informed, written consent Patients were randomized to a preemptive or control group. Preoperatively, patients were instructed the visual analog scale (VAS) for pain assessment Patient received premedication with midazolam 0,07 mg/kg iv, sulfas atropin 0,02 mg/kg, metoclopramide 10 mg/kg at the operating room. Anesthesia was induced with thiopental 5 mg/kg iv,. atracurium 0,5 mg/kg iv, fentanyl 2 mcg/kg was administered to facilitate tracheal intubation. Maintenance with atracurium 0,02 mg/kg W if needed. Maintenance of anesthesia consisted of 02:N230%:70% and isoflurane 1 %. In the preemptive group, a ketamine bolus of 0.5 mg/kg IV was administered atfer induction of general anesthesia before incision. Postoperatively, analgesia was achieved with meperidine 0,5 mg/kg iv as needed during the postanesthesia care unit (PACU) stay. The time that the patient first requested analgesic medication (TFA) was recorded if VAS pain scores > 3 cm (0-10 cm; 0 = no pain, 10 = worst pain imaginable), vital sign pre and post operative. Meperidine consumption totals were recorded for the ward stay. Result : There were no statistically significant differences between the two groups in meperidine consumption totals at 24 hours and VAS pain score, and there were statistically significant differences between the two groups in thr first opioid required time. Conclusion : Ketamine doses 0,5 mg/kgBB iv has no effect premptive analgesia at oncology surgery. Latar belakang : Asam amino eksitatori berperan dalam aktivasi saraf nosisepsi komu medula spinalis pada reseptor N-methyl-D-aspartate (NMDA). Data penelitian melaporkan reseptor NMDA berperan dalam proses sensitisasi sentral terhadap nyeri. Analgesia preemptif berdacar bahwa pemberian obat analgesia sebelum input nosisepsi dapat mencegah sensitisasi dan memperbaiki nyeri paska bedah. Tujuan : Mengetahui efektifitas ketamin sebagai analgesia preemptif terhadap derajat nyeri paska bedah onkologi. Metode : Merupakan penelitian eksperimental randomized post test only controlled group design. 42 pasien yang menjalani operasi elektif onkologi dengan anestesi umum inhalasi di RS Dr. Kariadi Semarang, memenuhi kriteria inklusi dan eksklusi dibagi dalam 2 kelompolc Dicatat tanda vital pm bedah. Premedikasi dengan midazolam 0,07 mg/kgBB iv, metoclopramid 10 mg iv, aulfas atropin 0,01 mg/kgBB. lnduksi dengan tiopental 5 mg/kgBB, atrakurium 0,5 mg/kgBB, fentanil 2 mcg/kgBB, dilakukan intubasi. Thunman anestesi dengan N20:02=70%:30%, isofluran 1%, atrakurium intermiten. Kelompok preemptif (I) diberi ketamin 0,5 mg/kgBB sebelum insisi, kelompok kontrol (II) diberi NaC1 0,9%. Selesai operasi pasien diekstubasi, dilalcukan observasi di ruang pemulihan. Bila skor nyeri atau nilai Visual Analog Scale (VAS) >3 cm diberi meperidin 0,5 mg/kgB13 iv. Dicatat tanda vital paska bedah, waktu pertama kali diberikan analgetik. Di bangsal, diberi analgetik meperidin 0,5 mg/kgBB bila VAS > 3 cm. Dicatat jumlah total kebutuhan meperidin. Efek samping yang terjadi dicatat. Hasi! : Jumlah meperidin yang diberikan dan nilai VAS dalam 24 jam tidak berbeda bermakna pada dua kelompok (p-M0,692) dan (p>0.05), dan berbeda bermakna pada waktu pertama kali diperlukan analgetik (p0,000). Simpulan Ketamin dosis 0,5 mg/kgBB iv tidak memberikan efek analgesia preemptif pada operasi bedah onkologi.