PENGARUH PEMBERIAN FENTANIL KONTINU DAN KETOROLAK INTRAVENA TERHADAP KETERCAPAIAN TARGET NYERI DAN LENGTH OF STAY (LOS) PASIEN PASCA OPERASI ORTOPEDI DI RSUP DR. SARDJITO YOGYAKARTA

NURUL IRNA WINDARI, Prof. Dr. Zullies Ikawati, Apt.; Dra. Eni Purwaningtyastuti, M.Sc., Apt.

2020 | Tesis | MAGISTER FARMASI KLINIK

Nyeri pasca operasi merupakan permasalahan yang paling sering dirasakan oleh pasien. Sebanyak 80% dari total pasien mengalami nyeri akut setelah prosedur operasi. Salah satu prosedur operasi yang banyak dilakukan adalah ortopedi. Ketorolak dan fentanil digunakan untuk penanganan nyeri pasca operasi ortopedi. Penanganan nyeri pasca operasi yang tepat dengan pemberian analgetik yang adekuat akan mempercepat pemulihan atau penurunan rasa nyeri dan mempersingkat waktu rawat inap pasien di rumah sakit. Penelitian ini bertujuan untuk mengetahui perbedaan pengaruh pemberian fentanil kontinu dan ketorolak intravena terhadap ketercapaian target nyeri dan Length of Stay (LOS) pasien pasca operasi ortopedi di RSUP Dr. Sardjito Yogyakarta. Penelitian ini menggunakan jenis rancangan penelitian cohort prospektif, yang dilakukan pada pasien rawat inap pasca operasi ortopedi di RSUP Dr. Sardjito Yogyakarta pada bulan Juli-Oktober 2019. Variabel Bebas dalam penelitian ini yaitu jenis analgetik yang diberikan meliputi fentanil kontinu dan ketorolak intravena, sedangkan variabel tergantung yaitu ketercapaian target nyeri dan LOS. Hubungan fentanil kontinu dan ketorolak intravena terhadap ketercapaian target nyeri dianalisis dengan uji Fisher, sedangkan hubungan dengan LOS dianalisis dengan uji Mann Whitney. Dominasi variabel terhadap luaran penelitian dianalisis dengan analisis Multivariat. Terdapat 59 pasien pasca operasi ortopedi dalam penelitian ini. Sebanyak 34 pasien mendapat terapi fentanil kontinu dan 25 pasien mendapat terapi ketorolak intravena. Tidak terdapat perbedaan pengaruh pemberian fentanil kontinu dan ketorolak intravena terhadap ketercapaian target nyeri (P = 0,711). Namun demikian, terdapat perbedaan pengaruh pemberian fentanil kontinu dan ketorolak intravena terhadap rata-rata LOS pasien di RS (P = 0,000). Fentanil kontinu dan ketorolak intravena sama-sama dapat menghasilkan ketercapaian target nyeri pasca operasi ortopedi yang adekuat, namun rata-rata LOS menjadi lebih singkat pada pasien dengan pemberian ketorolak intravena.

Postoperative pain is a problem most often suffered by patients. As many as 80% of the total patients experience acute pain after the surgical procedure. One of the many surgical procedures performed is orthopedics. Ketorolac and fentanyl are used for the management of postoperative orthopedic pain. Appropriate postoperative pain management with adequate analgesic administration will speed up recovery or decrease in pain and shorten the patient's hospital stay. This study aims to determine the differences in the effect of continuous fentanyl and intravenous ketorolac on the pain target achievement and the Length of Stay (LOS) of patients after orthopedic surgery at RSUP Dr. Sardjito Yogyakarta. This study uses a prospective cohort study design, which was conducted in postoperative ortopedic patients at Dr. RSUP. Sardjito Yogyakarta in July-October 2019. The independent variables in this study were the type of analgesics that included continuous fentanyl and intravenous ketorolac, while the dependent variable was a decrease in pain intensity and LOS. The relationship of continuous fentanyl and intravenous ketorolac to the achievement of pain targets was analyzed by Fisher's exact test, while the relationship with LOS was analyzed by Mann Whitney's test. The dominance of variables on the research outcomes was analyzed by Multivariate analysis. There were 59 postoperative ortopedic patients in this study. A total of 34 patients received continuous fentanyl therapy and 25 patients received intravenous ketorolac therapy. There was no difference in the effect of continuous fentanyl administration and intravenous ketorolac on pain target achievement (P = 0.711), while there were differences in the effect of continuous fentanyl administration and intravenous ketorolac on the average LOS of patients in the hospital (P = 0,000). Continent fentanyl and intravenous ketorolac can both produce the achievement of adequate postoperative orthopedic pain targets, but the mean LOS becomes shorter in patients with intravenous ketorolac.

Kata Kunci : Fentanil kontinu, ketorolak intravena, nyeri pasca operasi ortopedi, ketercapaian target nyeri, LOS; Continuous fentanyl, intravenous ketorolac, orthopedic postoperative pain, pain target achievement, LOS