Perbandingan Efek Analgesia antara Fentanil dan Oksikodon Intravena untuk Pengelolaan Nyeri Pascabedah Laparotomi Kolesistektomi

Thomas Thomas, Iwan Fuadi, Iwan Abdul Rachman

Abstract


Nyeri pascabedah harus diatasi dengan baik menggunakan analgetik yang memiliki efek analgesia adekuat dengan efek samping minimal. Penelitian ini bertujuan mengetahui perbedaan nyeri pascabedah laparotomi kolesistekomi yang dinilai dengan numeric rating score (NRS) antara pasien yang menggunakan continuous intravenous patient controlled analgesia (IV-PCA) fentanil dan oksikodon. Penelitian dilakukan pada periode Agustus–November 2020 di RSUP dr. Hasan Sadikin Bandung. Penelitian randomized control trial (RCT) dilakukan terhadap 32 subjek status fisik ASA I–II yang terbagi menjadi dua kelompok, yaitu kelompok yang mendapat continuous IV-PCA fentanil 0,5 µg/kgBB/jam dan kelompok dengan continuous IV-PCA oksikodon 30 µg/kgBB/jam. Nyeri pascabedah dinilai dengan NRS pada jam pertama, ke-6, ke-12, dan ke-24. Analisis statistik data numerik dengan Uji Mann-Whitney, data kategorik dengan uji chi-square dan alternatif Uji Fisher’s Exact. Nilai NRS pada kelompok oksikodon lebih rendah dibanding dengan fentanil pada jam pertama hingga jam ke-24 (p=0,001). Kebutuhan rescue analgetik pada jam pertama dan ke-6 juga lebih rendah pada kelompok oksikodon (p=0,012; p=0,022, berurutan). Penelitian dengan rasio fentanil:oksikodon 1:60 ini tidak menunjukkan perbedaan efek samping kejadian mual, muntah, pusing, sakit kepala, dan pruritus antara kedua kelompok. Pemberian analgesia oksikodon intravena pada pasien pascabedah laparotomi kolesistektomi lebih baik dibanding dengan fentanil intravena.


Comparison of Analgesia Effect between Intravenous Fentanyl and Oxycodone for Postoperative Pain Management after Laparotomy Cholecystectomy

Postoperative pain must be addressed properly with adequate analgetic drugs and minimal side effects. This study aimed to determine the differences in postoperative cholecystecomy laparotomy pain assessed by NRS in patients receiving continuous PCA fentanyl or oxycodone. This was a randomized clinical trial on 32 subjects between August-November 2020 at dr. Hasan Sadikin Hospital Bandung. These subjects were divided into two groups: the group that received continuous intravenous infusion of PCA fentanyl 0.5 µg/kgBW/hour and the group with continuous intravenous infusion of PCA oxycodone 30 µg/kgBW/hr. Thepostoperative pain was assessed by NRS at the 1st, 6th, 12th, and 24th hours. Statistical analysis of numerical data was performed using the Mann-Whitney test while the categorical data were analyzed using Chi-Square test with alternative uji Fisher’s Exact test. Results showed that NRS was lower in the oxycodone group than in the fentanyl group at the first to 24 hours (p=0.001). The need for analgesic rescue at the first and sixth hours was also lower in the oxycodone group (p=0.012; p=0.022, respectively). The observation of opioid side effects on fentanyl:oxycodone with a ratio of 1:60 did not present any difference in the incidence of nausea, vomiting, dizziness, headache, and pruritus in both groups. The administration of intravenous oxycodone in postoperative cholecystectomy laparotomy patients gives better analgesia effect than intravenous fentanyl.


Keywords


Fentanil, laparotomi kolesistektomi, nyeri pascabedah, oksikodon

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DOI: https://doi.org/10.15851/jap.v9n1.2386

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