EFEKTIFITAS ANALGESI BLOK TRANSVERSUS ABDOMINIS PLANE (TAP) BUPIVAKAINE 0,25% DAN EPINEFRINE 1 : 200.000 DENGAN KOMBINASI OBAT ANTI INFLAMASI NON STEROID (Studi Pasca Laparoskopi Ginekologi)

NOVI DWI AKHSANIATI, Dr. Bambang Suryono, Sp.An, KIC ,KAO.; Dr. Calcarina Fitriani Retno Wisudarti, Sp.An, KIC.

2017 | Tesis-Spesialis | SP ILMU ANESTESIOLOGI DAN REANIMASI

Latar belakang : Berbagai cara digunakan untuk mengatasi nyeri pasca laparoskopi. Obat-obatan seperti obat anti inflamasi non steroid, steroid, opioid ataupun dengan local anestesi sering dipakai untuk mengatasi nyeri pasca laparoskopi. Tujuan : Mengetahui efektifitas analgetik blok transversus abdominis plane bupivakaine 0,25% 20 cc di tiap sisi dan epinefrine 1 : 200.000 dikombinasi dengan obat anti inflamasi non steroid ketorolac 30 mg intravena sebagai analgetik pasien pasca laparoskopi ginekologi. Metode : Rancangan penelitian adalah Single Blind Randomized Control Trial. Sebanyak 42 pasien status fisik ASA I-II yang akan menjalani operasi laparoskopi ginekologi dengan anestesi umum yang memenuhi kriteria inklusi dibagi secara acak menjadi kelompok perlakuan dan kontrol. Kelompok perlakuan anestesi umum yang diberikan blok transversus abdominis plane 20 cc bupivakaine 0,25 % dan adjuvan epinefrin 1 : 200.0000 dan analgetik pasca operasi injeksi ketorolac 30 mg intravena. Kelompok kontrol anestesi umum yang diberikan injeksi analgetik pasca operasi ketorolac 30 mg intravena. Pasien diamati intensitas nyeri Numeric Rating Scale pasca operasi dan kebutuhan rescue analgetik fentanyl selama 24 jam pasca operasi Hasil : Terdapat perbedaan bermakna numeric rating scale pada kelompok kontrol pada saat di ruang pemulihan, jam ke 6 dan jam ke 12 (p<0.05). Kebutuhan rescue fentanyl yang lebih rendah pada kelompok perlakuan sampai dengan jam ke 6 pasca operasi (p<0.05) Kesimpulan : Kombinasi Blok Transversus Abdominis Plane dengan injeksi ketorolac 30 mg intravena efektif menurunkan nilai numeric rating scale dan menurunkan kebutuhan rescue fentanyl pasca operasi.

Background: Various methods are used to treat pain after laparoscopy. Drugs such as non-steroidal anti-inflammatory drugs, steroids, opioids or with local anesthesia is often used to treat pain after laparoscopy. Objective: To determine the effectiveness of transversus abdominis plane block and bupivacaine 20 cc of 0.25% on each side and epinefrine 1: 200,000 in combination with non-steroidal anti-inflammatory drug ketorolac 30 mg intravenously as an analgesic for post-laparoscopic gynecological patients. Methods: Design of this study is Single Blind Randomized Control Trial. Fourty two patients with ASA physical status I-II underwent gynecological laparoscopic surgery with general anesthesia met the inclusion criteria were randomly divided into treatment and control groups. The treatment group were given transversus abdominis plane block 20 cc bupivakaine 0.25% and adjuvant epinephrine 1: 200.0000 and postoperative analgesic ketorolac 30 mg intravenous injection. The control group was given analgesic ketorolac 30 mg intravenously. Patients were observed intensity of pain Numeric Rating Scale and the need for postoperative rescue analgesic fentanyl for 24 hours postoperatively Results: There were significant differences of numeric rating scale in the control group at the time in the recovery room, 6 hours and 12 hours (p <0.05). Needs fentanyl rescue was lower in the treatment group up to 6 hours postoperatively (P <0.05) Conclusion: The combination of transversus abdominis Block Plane with ketorolac 30 mg intravenous injection effectively lowers the value of Numeric Rating Scale and reduce the need for post-operative fentanyl rescue.

Kata Kunci : laparoskopi, ginekologi, blok transversus abdominis plane, ketorolac, analgetik, laparoscopy, gynaecology, transversus abdominis plane block, ketorolac, analgesic