Perbandingan Pemberian Morfin 15 mg Topikal dengan Bupivakain 0,25% Topikal pada Luka Operasi Modified Radical Mastectomy terhadap Waktu Bebas Nyeri dan Jumlah Kebutuhan Opioid Pascaoperasi

Irwan Setiadi; M. Andy Prihartono; Erwin Pradian

doi:10.15851/jap.v8n2.2038

Perbandingan Pemberian Morfin 15 mg Topikal dengan Bupivakain 0,25% Topikal pada Luka Operasi Modified Radical Mastectomy terhadap Waktu Bebas Nyeri dan Jumlah Kebutuhan Opioid Pascaoperasi

Irwan Setiadi, M. Andy Prihartono, Erwin Pradian

Abstract

Berbagai macam analgetik dapat diberikan untuk mengatasi nyeri pascaoperasi mastektomi, namun tidak ada yang ideal dalam menangani nyeri pascaoperasi. Teknik pemberian topikal adalah teknik terbaru untuk penanganan nyeri akut pascaoperasi modified radical mastectomy. Penelitian ini bertujuan membandingkan waktu bebas nyeri dan jumlah kebutuhan opioid pascaoperasi modified radical mastectomy. Penelitian menggunakan metode uji klinis acak terkontrol buta ganda melibatkan 38 pasien yang menjalani operasi modified radical mastectomy di RSUP Dr. Hasan Sadikin Bandung pada bulan November 2019–Februari 2020. Pasien dibagi menjadi dua kelompok, kelompok morfin 15 mg topikal (kelompok M, n=19) dan kelompok bupivakain 0,25% topikal (kelompok B, n=19). Analisis data menggunakan Uji Mann Whitney karena distribusi data tidak normal berdasar hasil Uji Shapiro-Wilk. Hasil penelitian didapatkan bahwa waktu bebas nyeri lebih lama pada kelompok M (846,78±411,80 menit) dibanding dengan kelompok B (401,52±123,19 menit) dengan perbedaan yang signifikan (p<0,05). Total kebutuhan opioid kelompok M lebih sedikit, yaitu sebesar 1,15±0,60 gram dibanding dengan kelompok B sebesar 3,84±0,89 gram dengan perbedaan yang signifikan (p<0,05). Simpulan penelitian adalah pemberian morfin topikal memberikan waktu bebas nyeri lebih lama dan jumlah kebutuhan opioid pascaoperasi lebih sedikit dibanding dengan pemberian bupivakain topikal untuk nyeri pascaoperasi modified radical mastectomy.

Comparison of Postoperative Pain Free Duration and Amount of Opioid Need between Topical 15 mg Morphine and 0.25% Bupivacaine Applications on Modified Radical Mastectomy Surgical Wound

Various analgesic methods are implemented for reducing postoperative mastectomy pain, but none of them are ideal. Topical administration is the latest technic for managing postoperative pain in modified-radical mastectomy. This study aimed to compare pain free duration and the amount of opioid needed to manage pain after modified-radical mastectomy. This randomized double-blind clinical trial study with 38 patients underwent modified radical mastectomy in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, was performed from November 2019 to February 2020. Subjects were divided into two groups, with one group received topical 15 mg morphine group (group M, n=19) and another received topical 0.25% bupivacaine group (group B, n=19). Data were analyzed using Mann Whitney test after they were proven to be non-normally distributed based on the results of the Shapiro-Wilk test. Results showed that the pain free duration was significantly longer in group M (846.78±411.80 minutes) when compared to group B (401.52±123.19 minutes) (p<0.05). The total dose needed for group M was 1,15±0,60 grams, which was significantly less than the dose needed in group B (384±0.89 grams) (p<0.05). In conclusion, topical morphine administration is associated with a longer pain free duration before the first onset of pain requiring opioid with less total amount of opioid needed when compared to bupivacaine for modified radical mastectomy postoperative pain.

Keywords

Bupivakain topikal, modified radical mastectomy, morfin topikal, nyeri pascaoperasi

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References

Perbandingan Pemberian Morfin 15 mg Topikal dengan Bupivakain 0,25% Topikal pada Luka Operasi Modified Radical Mastectomy terhadap Waktu Bebas Nyeri dan Jumlah Kebutuhan Opioid Pascaoperasi

Irwan Setiadi, M. Andy Prihartono, Erwin Pradian

Departemen Anestesiologi dan Terapi Intensif

Fakultas Kedokteran Universitas Padjadjaran/RSUP Dr. Hasan Sadikin Bandung

Abstrak

Lazaraviciute G, Chaturvedi S. Mastectomy - a critical review. Open J Clin Diagnostics. 2017;7:58–66.

Amaya F, Hosokawa T, Okamoto A, Matsuda M, Yamaguchi Y, Yamakita S, dkk. Can acute pain treatment reduce postsurgical comorbidity after breast cancer surgery? a literature review. Bio Med Res Int. 2015;2015:1–8.

Mohamed SA, Abdel-Ghaffar HS, Kamal SM, Fares KM, Hamza HM. Effect of topical morfin on acute and chronic postmastectomy pain. Am Soc Reg Anesth Pain Med. 2016;41(6):704–10.

Khalefa BI, Shaqura M, Al- Khaesani M. Relative contribution of peripheral versus supra-spinal or spinal opioid receptors to the anti-nociception of systemic opioid. Eur J Pain. 2012;16(5):690–705.

Loughran CF, Keeling CR. Seeding of tumour cells following breast biopsy: literature review. Br J Radiol. 2011:84(1006):869–74.

Jonnavithula N, Khandelia H, Durga P, Ramachandran G. Role of wound installation with bupivakain through surgical drains for postoperative analgesia in modified radical mastectomy. Indian J Anaesth. 2015;59:15–20.

Eltumi HG, Tashani OA. Effect of age, sex and gender on pain sensitivity: a narrative review. Open Pain J. 2017;10:44–55.

Helmond NV, Timmerman H, Dasselaar NT, Carmen C, Olesen S, Drewes AM, dkk. High body mass index is a potential risk factor for persistent posoperative pain after breast cancer treatment. Pain Physician. 2017;20:E661–71.

Admassu WS, Hailekiros AG, Abdisa ZD. Severity and risk factors of post-operative pain in University of Gondar Hospital, Northeast Ethiopia. J. Anesth Clin Res. 2016;7(10):1–7.

Lanitis S, Mimigianni C, Raptis D, Sourtse G, Sgourakis G, Karaliotas C. The Impact of educational status on the postoperative perception of pain. Korean J Pain. 2015;28(4):265–74.

Macres SM, Moore PG, Fishman SM. Acute pain management. Dalam: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R, dkk., penyunting. Clinical anesthesia. Edisi ke-8. Philadelphia: Wolters Kluwer; 2017. hlm. 3919–30.

Elzohry AAM, Elhamed MFA, Mahran MH. Mastectomy pain is no longer nightmare. J Pain Manage Med. 2018;4:1.

Leong C, Neumann C, Ramasamy S, Rout B, Wee LY, Bigliardi-Qi M, dkk. Investigating endogenous µ-opioid receptors in human keratinocytes as pharmacological targets using novel fluorescent ligand. PLoS ONE 2017;12(12):e0188607. https://doi.org/10.1371/journal.pone0188607.

Stein C, Julia L. Peripheral mechanisms of opioid analgesia. department of anaesthesiology and intensive care medicine freie Univercity Berlin Germany. J Elsevier. Curr Opini Pharmacol. 2009;9:3–8.

Mohamed SA, Abdel-Ghaffar HS. Effect of the addition of clonidine to locally administered bupivacaine on acute and chronic postmastectomy pain. J Clin Anessth. 2013;25:20–7.

DOI: https://doi.org/10.15851/jap.v8n2.2038