Perbandingan Bupivakain 0,25% dengan Kombinasi Bupivakain 0,25% dan Deksametason 8 mg pada Blok Transversus Abdominis Plane dengan Panduan Ultrasonografi sebagai Analgesia Pascahisterektomi
Abstract
Analgesia dinding abdomen anterior dan lateral dapat dilakukan dengan blok transversus abdominis plane (TAP). Penelitian ini bertujuan menilai waktu kebutuhan analgesik pertama dan skor nyeri 2, 4, 6, 12, 24 jam pascahisterektomi antara bupivakain 0,25% dengan kombinasi bupivakain 0,25% dan deksametason 8 mg pada blok TAP. Penelitian menggunakan uji klinis acak terkontrol buta tunggal, dilakukan di Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung pada bulan Oktober–Desember 2017. Pasien dibagi menjadi grup bupivakain 0,25% (grup B, n=20) dan grup kombinasi bupivakain 0,25% deksametason 8 mg (grup BD, n=20). Uji statistik menggunakan uji-t berpasangan, Uji Wilcoxon, dan uji chi-square. Hasil penelitian mengungkapkan waktu kebutuhan analgesik pertama lebih lama pada grup BD (866,45±98,11 menit) dibanding dengan grup B (352,75±43,32 menit) dengan perbedaan signifikan (p<0,05). Median skor nyeri pascahisterektomi grup BD pada 4 jam (1), 6 jam (2), 12 jam (2), dan 24 jam (2) lebih rendah dibanding dengan grup B dengan median skor nyeri 4 jam (2), 6 jam (3), 12 jam (4), dan 24 jam (3), dengan perbedaan signifikan (p<0,05). Simpulan penelitian ini adalah kombinasi bupivakain 0,25% dan deksametason 8 mg pada blok TAP menghasilkan waktu kebutuhan analgesik pertama lebih lama dan skor nyeri pascahisterektomi lebih rendah dibanding dengan bupivakain 0,25%.
Kata kunci: Blok transversus abdominis plane, deksametason, skor nyeri, waktu kebutuhan analgesik pertama
Comparison between 0.25% Bupivacaine and Combination of 0.25% Bupivacaine and 8 mg Dexamethasone on Transversus Abdominis Plane Block Ultrasound-guided as Post- Hysterectomy Analgesia
Analgesia for anterior and lateral abdominal walls can be provided through transversus abdominis plane (TAP) block. This study aimed to evaluate the timing of first analgesic requirement and post- hysterectomy pain scores at 2, 4, 12, 24 hours between 0.25% bupivacaine and combination of 0.25% bupivacaine and 8 mg dexamethasone on TAP block. This was a randomized single-blind controlled trial study on patients Dr. Hasan Sadikin Hospital (RSHS) Bandung in the period of October–December 2017. Patients were randomly divided into 0.25% bupivacaine (B group, n=20) and o0.25% bupivacaine 8 mg dexamethasone combination (BD group, n=20). Statistical test was performed using paired t test, Wilcoxon test, and chi-square test. It was revealed that the time to first analgesic requirement was longer in BD group (866.45±98.11 minutes) than in B group (352.75±43.32 minutes) with a significant difference (p<0.05). The post-hysterectomy pain score medians in BD group at 4 hours (1), 6 hours (2), 12 hours (2), and 24 hours (2) were lower than those of B group with a significant difference (p<0.05). Therefore, 0.25% bupivacaine and 8 mg dexamethasone combination for ultrasound-guided TAP block presents longer time to first analgesic requirement and lower pain score compared to 0.25%. bupivacaine
Key words: Dexamethasone, pain score, time to first analgesic requirement, transversus abdominis plane block
Keywords
Full Text:
PDFReferences
akasai A. Complications of hysterectomy: a review. BJS. 2013;9(2):78‒87.
Gharaei H, Imani F, Almasi F, Solimani M. The effect of ultrasound‒guided TAPB on pain management after total abdominal hysterectomy. Korean J Pain. 2013;26(4):374‒8.
Ammar AS, Mahmoud KM. Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: a prospective randomized controlled trial. Saudi J Anaesth. 2012;6(3):229‒33.
Apfelbaum JL, Ashburn MA, Connis RT, Gan TJ, Nickinovich DG. Practice guidelines for acute pain management in the perioperative setting. ASA. 2012;116(2):248‒73.
Bhaskar SB. Case for local infiltration analgesia: is all the evidence in black and white?. Indian J Anaesth. 2015;59(1):1‒4.
Champaneria R, Shah L, Geoghegan J, Gupta JK, Daniels JP. Analgesic effectiveness of transversus abdominis plane blocks after hysterectomy: a meta‒analysis. Eur J Obstet Gynecol Reprod Biol. 2013;166:1‒9.
Macres SM, Moore PG, Fishman SM. Acute pain management. Dalam: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R, penyunting. Clinical anesthesia. Edisi ke-7. Philadelpia: Lippincott Williams & Wilkins; 2013. hlm. 1611‒44.
Brummett CM, Williams BA. Additives to local anesthetics for peripheral nerve blockade. Int Anesthesiol Clin. 2011;49(4):104‒16.
Gulhas N, Kayhan G, Sanh M, Kitlik A, Durmus M. Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block. Med‒Science. 2015;4(4):2732‒42.
Eltumi HG, Tashani OA. Effect of age, sex and gender on pain sensitivity: a narrative review. TOPAINJ. 2017;10:44–55.
Capmbell AL, Yu S, Karia R, Iorio R, Stuchin SA. The effects of body mass index on pain control with liposomal bupivacaine in hip and knee arthroplasty. J Arth. 2017;33(4): 1033–9.
Gwam CU, Mistry JB, Mohamed NS, George NE, Etcheson JI, Virani S, dkk. The effect of preoperative physical status on pain management in total knee arthroplasty patients receiving adductor canal blockade. Surg Technol Int. 2017;9(31):897.
Macintyre PE, Scott DA, Schug SA, Visser EJ, Walker SM. Physiologi and psychology of acute pain. Dalam: Macintyre PE, Scott DA, Schug SA, Visser EJ, Walker SM, penyunting. Acute pain management: scientivic evidence. Edisi ke 3. Melbourne: Australian and New Zealand College of Anaesthetists; 2010. hlm. 1‒33.
Fouad HA, Ahmed AMS, Mohammed Y, Osman M, Abouelmag GMT. Efficacy of preemptive dexamethasone added to bupivacaine in ultrasound guided transversus abdominis plain block for postoperative analgesia after inguinal herniorraphy. AJRC. 2016;4(5):1‒16.
Yang S, Zhang L. Glucocorticoids and vascular reactivity. Current Vascular Pharmacol. 2004;2(1):1‒12.
Lin Y, Liu SS. Local anesthetics. Dalam: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R, penyunting. Clinical anesthesia. Edisi ke-7. Philadelpia: Lippincott Williams & Wilkins; 2013. hlm. 561‒79.
Castillo J, Curley J, Hotz J, Uezono M, Tigner J, Chasin M, dkk. Glucocorticoids prolong rat sciatic nerve blockade in vivo from bupivacaine microspheres. Anesthesiology. 1996;85:1157‒66.
Ma C, LaMotte RH. Multiple sites for generation of ectopic spontaneous activity in neurone of the chronically compressed dorsal root ganglion. J Neurosci. 2007;27(51):14059‒68.
Bailard NS, Ortiz J, Flores RA. Additives to local anesthetics for peripheral nerve blockade: evidence, limitations, and recommendations. Am J Health-Syst Pharm. 2014;71:373‒83.
Macres SM, Moore PG, Fishman SM. Acute pain management. Dalam: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R, penyunting. Clinical anesthesia. Edisi ke-7. Philadelpia: Lippincott Williams & Wilkins; 2013. hlm. 1611‒44.
DOI: https://doi.org/10.15851/jap.v6n2.1240
Article Metrics
Abstract view : 525 timesPDF - 292 times
This Journal indexed by
JAP is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
View My Stats