Perbandingan Infus Kontinu Lidokain dan Morfin terhadap Skor Visual Analog Scale serta Kadar Neutrofil-Limfosit Ratio Pascalaparotomi

Adi Kurniawan, Purwoko Purwoko, Fitri Hapsari Dewi, Andy Nugroho, Paramita Putri Hapsari

Abstract


Morfin sebagai analgetik pada laparotomi memiliki efek samping yang merugikan dan potensi menyebabkan kecanduan. Infus lidokain intravena (IVLI) merupakan alternatif analgetik perioperatif yang di nilai lebih aman dan efektif. Penelitian ini bertujuan membandingkan efektivitas pemberian IVLI dan morfin terhadap nyeri serta kadar Neutrophil-Lymphocyte Ratio (NLR) pascalaparotomi. Penelitian ini merupakan uji klinis acak tersamar ganda yang melibatkan 46 pasien laparotomi di RSUD Dr. Moewardi yang memenuhi kriteria inklusi dan eksklusi. Pemberian IVLI bolus 1,5 mg/kg saat induksi dilanjutkan infus 1 mg/kgBB/jam dibanding dengan morfin bolus 15 mcg/kg dilanjutkan infus kontinu 10 mcg/kg/jam. Hasil menunjukkan penurunan skor nyeri VAS pada jam ke-4, 8, dan 24 lebih baik pada kelompok lidokain, meskipun tidak signifikan secara statistik (p=0,128; p=0,097; p=0,100). Penurunan NLR juga lebih baik pada kelompok lidokain namun tidak signifikan (p=0,941). Simpulan, IVLI memberikan efek analgetik yang lebih baik dibanding dengan morfin berdasarkan penurunan skor VAS dan kadar NLR, namun tidak menunjukkan perbedaan yang bermakna secara statistik.

Keywords


Laparotomi; lidokain; morfin; NLR; VAS

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References


  1. Sacerdote P, Coluzzi F, Fanelli A. Sublingual sufentanil, a new opportunity for the improvement of postoperative pain management in Italy. Eur Rev Med Pharmacol Sci. 2016;20(7):1411–22.
  2. Gan TJ. Poorly controlled postoperative pain: Prevalence, consequences, and prevention. J Pain Res. 2017;10:2287–98. doi: 10.2147/JPR.S144066.
  3. Thapa P, Euasobhon P. Chronic postsurgical pain: current evidence for prevention and management. 2018;31(3):155–73. doi: 10.3344/kjp.2018.31.3.155.
  4. Kandil E, Melikman E, Adinoff B. Lidocaine infusion: A promising therapeutic approach for chronic pain. J Anesth Clin Res. 2017;8(1):697. doi: 10.4172/2155-6148.1000697.
  5. Song X, Sun Y, Zhang X, Li T, Yang B. Effect of perioperative intravenous lidocaine infusion on postoperative recovery following laparoscopic Cholecystectomy-A randomized controlled trial. Int J Surg. 2017;45:8–13. doi: 10.1016/j.ijsu.2017.07.042.
  6. Lauren KD, Marcel ED. Perioperative use of intravenous lidocaine. American Society of Anesthesiologists. 2017;126(4):729–37. doi: 10.1097/ALN.0000000000001527.
  7. Ibrahim A, Aly M, Farrag W. Effect of intravenous lidocaine infusion on long-term postoperative pain after spinal fusion surgery. Medicine (Baltimore). 2018;97(13):e0229. doi: 10.1097/MD.0000000000010229.
  8. Putranto AS, Pramesta BD. Neutrophil-lymphocyte-ratio as predictor of morbidity and mortality in adults with gastrointestinal obstruction. The New Ropanasuri Journal of Surgery. 2023;8(3):10–23. doi:10.7454/nrjs.v8i3.1195.
  9. Akhgar A, Pouryousefi T, Nejati A, Rafiemanesh H, Hossein-Nejad H. The efficacy of intravenous lidocaine and its side effects in comparison with intravenous morphine sulfate in patients admitted to the ED with right upper abdominal pain suspected of biliary colic. Am J Emerg Med. 2021;44:300–5. doi: 10.1016/j.ajem.2020.04.010.
  10. Mendonça FT, Reis MC, Aguiar JA, Calvano LA. Systemic lidocaine for perioperative analgesia: A literature review. J Anest Inten Care Med. 2015;1(1):555551. doi:10.19080/JAICM.2015.01.555551.
  11. Weibel S, Jokinen J, Pace NL, Schnabel A, Hollmann MW, Hahnenkamp K, dkk. Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: A systematic review with trial sequential analysis. Br J Anaesth. 116(6):770–83. doi: 10.1093/bja/aew101.
  12. Soto G, Naranjo González M, Calero F. Intravenous lidocaine infusion. Rev Esp Anestesiol Reanim. 2018;65(5):269–74. doi: 10.1016/j.redar.2018.01.004.
  13. Yang X, Wei X, Mu Y, Li Q, Liu J. A review of the mechanism of the central analgesic effect of lidocaine. Medicine.2020;99(17):19898. doi: 10.1097/MD.0000000000019898.
  14. Karnina R, Arif SK, Hatta M, Bukhari A. Molecular mechanisms of lidocaine. Ann Med Surg. 2021;69:102733. doi: 10.1016/j.amsu.2021.102733.
  15. Joe-ikechebelu NN, Uchenna G, Ugwu EO, Okafor CD, Nwachukwu CE, Okam PC, dkk. A randomized controlled trial on efficacy and safety of trocar-site infiltration with lidocaine for postoperative pain relief after diagnostic laparoscopy. Gynecol Obstet Invest. 2019;84(1):71–8. doi: 10.1159/000490565.
  16. Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases. Int J Mol Sci. 2022;23(7):3636. doi: 10.3390/ijms23073636.
  17. Dąbrowska AM, Słotwiński R. The immune response to surgery and infection. 2014;39(4):532–7.doi:10.5114/ceji.2014.47741.
  18. Chen C, Cong BL, Wang M, Abdullah M, Wang XL, Zhang YH, dkk. Neutrophil to lymphocyte ratio as a predictor of myocardial damage and cardiac dysfunction in acute coronary syndrome patients. Integr Med Res. 2018;7(2):192–9. doi: 10.1016/j.imr.2018.02.006.
  19. Shu B, Xu F, Zheng X, Zhang Y, Liu Q, Li S, dkk. Change in perioperative neutrophil-lymphocyte ratio as a potential predictive biomarker for chronic postsurgical pain and quality of life: an ambispective observational cohort study. Front Immunol. 2023;14:1177285. doi: 10.3389/fimmu.2023.1177285
  20. Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophil to lymphocyte ratio: An emerging marker of the relationships between the immune system and diseases. 2012;23(7):3636.doi: 10.3390/ijms23073636.
  21. Doyle E, Bowler G. Pre-emptive effect of multimodal analgesia in thoracic surgery. Survey of Anesthesiology. 1998;80(2)147–51. doi: 10.1093/bja/80.2.147.
  22. Bahrudin M. Patofisiologi nyeri. Jurnal Ilmu Kesehatan dan Kedokteran Keluarga. 2017;13(1):1–57. doi: https://doi.org/10.22219/sm.v13i1.5449.
  23. LeMone P, Burke MK. Medical-surgical nursing: Critical thinking in clien care. New Jersey: Pearson education Inc; 2016.
  24. Erlangga E, Sitanggang RH, dan Bisri T. Perbandingan pemberian deksametason 10 mg dengan 15 mg intravena sebagai adjuvan analgetik terhadap skala nyeri pascabedah pada pasien yang dilakukan radikal mastektomi termodifikasi. Jurnal Anestesi Perioperatif. 2015;3(3):146–54.




DOI: https://doi.org/10.15851/jap.v13n1.3884

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