Perbandingan Intensitas Nyeri dan Kadar Prostaglandin Kombinasi Tramadol dan Deksketoprofen dengan Tramadol dan Parasetamol Intravena pada Pasien Bedah Ortopedi Ekstremitas Bawah

Clara Valentia Josephine, Muhammad Ramli Ahmad, Hisbullah Hisbullah, Abdul Wahab

Abstract


Analgesia multimodal adalah prinsip manajemen nyeri pascaoperasi. Penelitian ini merupakan uji klinis rancangan acak tersamar ganda. Tujuan penelitian ini membandingkan efek kombinasi analgesik tramadol dan deksketoprofen dengan tramadol dan parasetamol terhadap intensitas nyeri dan kadar prostaglandin (PGE2) di RSUP Dr. Wahidin Sudirohusodo serta Rumah Sakit Jejaring di Makassar pada bulan Juli–September 2018. Empat puluh enam pasien ASA PS I dan II yang menjalani operasi ortopedi ekstremitas bawah dibagi menjadi dua kelompok. Kelompok D adalah pasien yang menerima 50 mg tramadol dengan 50 mg deksketoprofen dan kelompok P adalah pasien yang menerima 50 mg tramadol dengan 1.000 mg parasetamol intravena. PGE2 dan intensitas nyeri dicatat selama penutupan kulit sebelum pemberian obat 8 dan 16 jam sesudahnya. Data dianalisis menggunakan Uji Mann-Whitney U dan paired t-test yang sesuai. Numeric rating scale (NRS) kelompok tramadol dan deksketoprofen lebih rendah dibanding dengan kelompok tramadol dan parasetamol dengan perbedaan bermakna (p<0,05). Kadar PGE2 menurun pada kelompok tramadol dan deksketoprofen (T1–T2 p=0,009 dan T0–T2 p=0,01), sedangkan kadar PGE2 pada kelompok tramadol dan parasetamol meningkat (T2–T1 p=0,227 dan T0–T2 p=0,706). Simpulan, kombinasi tramadol dan deksketoprofen mengurangi tingkat PGE2 dan intensitas nyeri dibanding dengan kombinasi tramadol dan parasetamol.

 

Dexketoprofen Combination and Tramadol Paracetamol Combination in Lower Limb Orthopedic Surgery

Multimodal analgesia is one of the principles of postoperative pain management. This study aimed to compare the effect of analgesic combination of tramadol dexketoprofen and tramadol paracetamol on pain intensity and prostaglandin (PGE2) level. Forty-six ASA PS I and II patients undergoing lower limb orthopedic surgery were allocated into two groups. Group D received 50 mg tramadol with 50 mg dexketoprofen and group P received 50 mg tramadol with 1,000 mg paracetamol intravenously. The PGE2 and pain intensity were recorded during skin closure prior to drug administration, 8 and 16 hours afterwards. Data were analyzed as appropriate using Mann-Whitney U and paired t-test. The NRS of two groups were significantly different where the NRS of the Tramadol Dexketoprofen group was lower than that of the tramadol and paracetamol group (NRS T1 p=0.049, NRS T2 p=0.035). The PGE2 levels decreased in the tramadol dexketoprofen groups (T1–T2 p=0.009 and T0–T2 p=0.01), whereas PGE2 levels in tramadol paracetamol group increased (T2–T1 p=0.227 and T0–T2 p=0.706). In conclusion, tramadol dexketoprofen combination reduces the PGE2 level and pain intensity as opposed to tramadol paracetamol combination.

 


Keywords


Deksketoprofen; parasetamol; PGE2; tramadol

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References


Brandsborg B, Dueholm M, Jensen TS, Nikolajsen L. Mechanosensitivity before and after hysterecyomy a prospective study on the prediction of acute and chronic postoperative pain. Br J Anaesth. 2011;9:1–8.

Garimella V, Cellini C. Postoperative pain control. Clin Colon Rectal Surg. 2013;26(3);191–6.

Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesth. 2009;22:588–93.

Brandsborg B, Dueholm M, Jensen TS, Nikolajsen L. Mechanosensitivity before and after hysterecyomy a prospective study on the prediction of acute and chronic postoperative pain. Br J Anaesth. 2011;9:1–8.

Chou R, Gordon DB, Casasola L, Rosenberg JM, Bickler S, Brennan T, dkk. Guideline on the management of postoperative pain. J Pain. 2016;17(2):137–57.

Sawaddiruk P, Paiboonworachat S, Janthawichai K. Comparison of efficacy and effectiveness between ultracet and tramadol/acetaminophen in acute postoperative pain after upper extremity surgery. J Med Assoc Thail. 2010;93(7):812–7.

Pergolizzi JV, van de Laar M, Langford R. Tramadol-paracetamol Fixed-dose combination in the treatment of moderate to severe pain. J Pain Res. 2012;5:327–46.

Vadivelu N, Mitra S, Narayan D. Review recent advances in postoperative pain management. Yale J Biol Med. 2010;83(1):11–25.

Ali S, Sofi K, Dar AQ. Comparison of intravenous infusion of tramadol alone with combination of tramadol and paracetamol for postoperative pain after major abdominal surgery in children. Anesth Essays Res. 2017;11(2):472–6.

McQuay HJ, Moore RA, Berta A, Gainutdinovs O, Fülesdi B, Porvaneckas N.. Randomized clinical trial of dexketoprofen/tramadol 25 mg/75 mg in moderate-to-severe pain after total hip arthroplasty. Br J Anaesth. 2016;116(2):269–76.

Kesimci E, Gümüş T, Izdeş S, Sen P, Kanbak P. Comparison of efficacy of dexketoprofen versus paracetamol on postoperative pain and morphine consumption in laminectomy patients. Agri. 2011;23:153–9.

Andrew M, Jodie B. Systemic review of dexketoprofen in acute and chronic pain. Biomed Cen Clin Phar. 2008;8(11):1–11.

Tunali Y, Akçil EF, Dilmen OK, Tutuncu AC, Koksal GM, Akbas S. Efficacy of intravenous paracetamol and dexketoprofen on postoperative pain and morphine consumption after a lumbar disk surgery. J Neurosurg Anesthesiol. 2013;25(2):143–7.

Graham GG, Davies MJ, Day RO, Mohamudally A, Scott KF. The modern pharmacology of paracetamol: therapeutic actions, mechanism of action, metabolism, toxicity and recent pharmacological findings. Inflammopharmacology. 2013;21 (3): 201–32.

Samad TA, Sapirstein AA, Woolf CJ. Prostanoid and pain unraveling mechanism and revealing therapetic targets. Trens Mol Med. 2012;8:390–6.

Kiliçaslan A, Tuncer S, Yüceaktaş A, Uyar M, Reisli R. The effects of intravenous paracetamol on postoperative analgesia and tramadol consumption in cesarean operations. Agri. 2010;22(1):7–12.

Moore RA, Gay-Escoda C, Figueiredo R, Tóth-Bagi Z, Dietrich T, Milleri S. Dexketoprofen/tramadol: randomised double-blind trial and confirmation of empirical theory of combination analgesics in acute pain. J Headache Pain. 2015;16:541–6.

Carli F, Baldini G. Perioperative pain management and enchanced outcomes. Dalam: Butterworth JF, Mackey DC, Wasnick JD, penyunting. Clinical anesthesilogy. Edisi ke-5. New York: McGraw-Hill; 2013. hlm. 1087–105.

Apfelbaun JL, Asburn MA, Connis RP, Gan TJ, Nickinovich DG. Practice guidelines for acute pain management in the perioperative setting. Anesthesiology. 2012;5(116):248–73.




DOI: https://doi.org/10.15851/jap.v7n2.1691


 

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