Perbandingan Bupivakain Infiltrasi Subkutis dengan Kombinasi Bupivakain Intramuskular Rectus Abdominis dan Subkutis terhadap Mulai Pemberian dan Kebutuhan Analgetik Rescue Pascaoperasi Laparatomi Ginekologi

Abstract

Penanganan nyeri pascaoperatif kurang baik akan membuat pasien trauma terhadap pembedahan dan menimbulkan komplikasi lain. Penelitian ini bertujuan membandingkan pemberian bupivakain secara kombinasi intramuskular (IMSK) dan subkutis dengan pemberian subkutis saja (SK) terhadap mulai pemberian dan kebutuhan analgetik rescue pascaoperasi laparatomi ginekologi. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung bulan September–Desember 2014 terhadap 46 wanita (18–60 tahun) status fisik American Society of Anesthesiology (ASA) I–II yang menjalani pembedahan laparatomi ginekologi secara uji acak terkontrol buta ganda dalam anestesi umum. Pasien dibagi menjadi dua, yaitu 23 orang menerima bupivakain kombinasi pada otot rectus abdominis dan subkutis dan 23 orang menerima bupivakain infiltrasi subkutis saja. Penilaian skala nyeri menggunakan nilai numeric rating scale dan dilakukan pencatatan pada jam ke-1, 2, 3, 4, 5, 6, 8, 12, dan 24 pascaoperasi. Pemberian analgetik rescue dilakukan bila nilai NRS ≥4. Data dianalisis dengan uji-t, chi-kuadrat, dan Mann-Whitney. Pada penelitian ini ditemukan waktu mulai pemberian analgetik rescue pada kelompok IMSK lebih lama (p<0,01) dan kebutuhan analgetik tambahan dalam 24 jam lebih sedikit (p<0,01) dibanding dengan kelompok SK. Simpulan, pemberian bupivakain secara kombinasi intramuskular dan subkutis lebih baik dibanding dengan pemberian subkutis saja terhadap waktu mulai pemberian dan kebutuhan analgetik rescue dalam 24 jam pascaoperasi laparatomi ginekologi.

Kata kunci: Bupivakain, numeric rating scale, otot rectus abdominis

Comparison between Subcutis Bupivacaine Infiltration and Combined Intramuscular Rectus Abdominal and Subcutis Bupivacaine to on Total Need of Rescue Analgesics after Gynecologic Laparatomy

Abstract

Inappropriate management of post-operative pain will cause trauma to the patient regarding the surgical experience and may possibly cause other complications. This study aimed to compare the administration of intramuscular and subcutis bupivacaine to subcutis only bupivacaine on the start and need for rescue analgesics. This study was conducted in Dr. Hasan Sadikin General Hospital Bandung during the period of September–December 2014 on 46 females aged 18–60 years old with American Society of Anesthesiology (ASA) I–II who underwent gynecological laparatomy under general anesthesia. This was a randomized controlled study. Patients were dividedinto two groups of 23 patients with the first group received combination infiltration and the other received only subcutis administration. The pain scale used was the numerical rating scale measured -1, 2, 3, 4, 5, 6, 8, 12, and 24 hours after surgery. Rescue analgesics was given if NRS was more than 4. Data were analyzed using t-test, chi-square test, and Mann-Whitney test. Observations were performed on time span until there was a need for analgesics for the first time and additional analgesic needed in 24 hours. In this study, the time span until the first dose analgesics was needed was longer and the amount of required analgesics during 24 hours was lower in the combination group (p<0.01). In conclusion, the combination strategy has a better outcome regarding the time span to the start of rescue analgetic and 24 hours analgesic needs.

Key words: Bupivacaine, numeric rating scale, abdominal recti muscle