PENGARUH PEMBERIAN PERORAL METILPREDNISOLON DIBANDINGKAN KETOROLAC TROMETHAMINE PRAODONTEKTOMI TERHADAP NYERI, EDEMA DAN TRISMUS PASCAODONTEKTOMI IMPAKSI MOLAR TIGA MANDIBULA

KAROLINA BR KABAN, drg. Rahardjo, Sp.BM(K); drg. Poerwati Soetji Rahajoe, SpBM(K)

2017 | Tesis-Spesialis | SP ILMU BEDAH MULUT

Odontektomi adalah suatu cara pengambilan gigi yang impaksi atau gigi yang terpendam. Odontektomi ini merupakan tindakan bedah yang sering dilakukan. Tindakan ini dapat berakibat kerusakan pada jaringan lunak dan keras, sehingga dapat mengakibatkan timbulnya nyeri, edema dan trismus, yang menyebabkan ketidaknyaman pascaodontektomi. Penelitian ini bertujuan mengetahui pengaruh pemberian obat peroral metilprednisolon 8 mg dibandingkan dengan ketorolac tromethamine 10 mg, 30 menit praodontektomi gigi molar tiga mandibula, terhadap nyeri, edema dan trismus paskaodontektomi. Rancangan penelitian dengan double blind randomized control trial, menggunakan 60 pasien, yang akan dilakukan odontektomi molar tiga mandibula, pada Poliklinik Bedah Mulut RSGM UGM Prof. Soedomo, sesuai dengan kriteria inklusi dan eksklusi yang ditetapkan, dibagi menjadi tiga kelompok yakni kelompok ketorolac tromethamine (20 orang), kelompok kontrol (20 orang) dan kelompok metilprednisolon (20 orang). Pengamatan terhadap nyeri (dilihat dari skore VAS), edema (dilihat dari pembengkakan pipi) dan trismus (dilihat dari kemampuan membuka mulut) paskaodontektomi, dilakukan pada H+0 (segera sesudah suturing), H+1 (hari pertama paskaodontektomi dan H+7 (hari ketujuh paskaodontektomi). Uji mancova dengan kovariat lama bedah, menunjukkan peroral metilprednisolon 8 mg 30 menit praodontektomi secara signifikan mengurangi nyeri (p<0,05), edema (p<0,05), trismus (p<0.05) paskaodontektomi molar tiga mandibula. Jumlah pemakaian analgetik pada kelompok metilprednisolon paling sedikit dibandingkan kelompok ketorolac tromethamine dan kontrol. Kesimpulan menunjukkan bahwa peroral metilprednisolon 8 mg yang diberikan 30 menit praodontektomi, lebih poten dibanding peroral ketorolac tromethamine 10 mg dalam mengurangi nyeri, edema, trismus dan pada kelompok metilprednisolon terdapat penurunan pemakaian analgetik paskaodontektomi molar tiga mandibula.

Odontectomy is surgical removal of impacted or unerupted tooth which requires mucoperiosteal flap followed with removal of bone overlying the tooth. This odontectomy has become one of the most common procedure in oral surgery. It is frequently associated with debilitating acute complications including pain, swelling, and trismus resulting in postoperative discomfort. This study aimed to compare the efficacy of the oral administration of 8 mg methylprednisolone and 10 mg ketorolac tromethamine 30 minutes before surgery on pain, swelling and trismus following odontectomy of impacted lower third molar. An experimental study with double blind randomized control trial method was used in this study. A total of 60 patients, who came to the Oral and Maxillofacial Surgery Department of the Dental Hospital of Prof. Soedomo, UGM, was divided into three groups which met the inclusion and exclusion criterias. Group I: twenty patients treated with ketorolac tromethamine, Group II: twenty patients as control group, and Group III: twenty patients treated with methylprednisolone. Postoperative evaluation on pain (visual analog scale scoring), swelling (facial edema measurement), and trismus (optimum mouthopening ability) was done on day 0 (immediately following wound suturing), day 1 (24 hour postoperative) and day 7 (1 week postoperative). Mancova test with the length of surgery covariates showed that the oral administration of 8 mg methylprednisolone 30 minutes before surgery significantly reduced pain (p<0,05), swelling (p<0,05), and trismus (p<0,05) following odontectomy of impacted lower third molar. The use of analgetics in the methylprednisolone group was found least compared with other groups. The results of this study concluded that the efficacy of the oral administration of 8 mg methylprednisolone 30 minutes before surgery was more potent than 10 mg ketorolac tromethamine in reducing pain, swelling, and trismus. There was a decreased on analgetics in methylprednisolone group following odontectomy of impacted lower third molar.

Kata Kunci : metilprednisolon 30 menit praodontektomi, nyeri, edema, trismus