PERBANDINGAN EFEKTIVITAS ANTARA KOMBINASI ORAL PARASETAMOL PLUS DEXKETOPROFEN DENGAN PARASETAMOL PLUS MORFIN LEPAS LAMBAT (MST) DALAM MENGATASI NYERI PASCABEDAH SESAR METODE ENHANCED RECOVERY AFTER CESAREAN SURGERY (ERACS)
Rahmadaniyah, Prof. Dr. apt. Agung Endro Nugroho, M.Si; Prof. apt. Zullies Ikawati, Ph.D
2024 | Tesis | S2 Mag.Farmasi Klinik
Latar Belakang: Nyeri pascabedah sesar seringkali bersifat akut dengan
intensitas sedang hingga berat. Pendekatan analgesik multimodal direkomendasikan
untuk mencapai efektivitas yang optimal dan meminimalkan efek samping.
Kombinasi parasetamol dan morfin lepas lambat (MST) efektif untuk nyeri
pascabedah, namun penggunaan morfin dibatasi hanya jika dibutuhkan saja. Alternatif
yang disarankan adalah kombinasi perasetamol dengan AINS (Antiinflamasi non-steroid) seperti dexketoprofen, yang memiliki onset
kerja cepat dan efek sentral pada sistem saraf pusat.
Tujuan: Membandingkan efektivitas dan keamanan antara kombinasi
parasetamol plus dexketoprofen dengan kombinasi parasetamol plus morfin lepas
lambat (MST) dalam mengatasi nyeri pascabedah sesar metode ERACS.
Metode: Uji klinis tersamar acak ganda (double blind randomized controlled
trial) dilakukan pada pasien pascabedah sesar metode ERACS periode Juli – Agustus
2024. Pengambilan subjek menggunakan consecutive sampling sebanyak 40
pasien, yang dikelompokkan menjadi dua kelompok yaitu kelompok kombinasi parasetamol 750 mg plus dexketoprofen 25 mg sebanyak
20 pasien dan kelompok kombinasi parasetamol 750 mg plus
morfin lepas lambat (MST) 10 mg sebanyak 20 pasien. Efektivitas dilihat
dari proporsi pasien yang mencapai target bebas nyeri (skor VAS < 3>Chi-square dan fisher’s Exact.
Hasil: Tidak terdapat perbedaan
signifikan dalam proporsi pasien yang tidak nyeri antara kelompok pemberian
kombinasi analgesik parasetamol 750 mg plus dexketoprofen 25 mg dan kombinasi
parasetamol 750 mg plus MST 10 mg, masing-masing 18 pasien (90%) dan 14 pasien
(70%) (p value 0,235). Kejadian efek samping ditemukan
hanya pada pemberian parasetamol plus MST yaitu 2 pasien mengalami mual muntah dan
1 pasien mengalami pusing.
Kesimpulan : Pemberian parasetamol
plus dexketoprofen memiliki efektivitas yang sama dengan pemberian parasetamol
plus MST untuk mengatasi nyeri pascabedah sesar metode ERACS dan bisa menjadi
alternatif untuk menggantikan pemberian parasetamol plus MST jika tanpa
kontraindikasi.
Background: Post-cesarean surgical pain is often acute
with moderate to severe intensity. A multimodal analgesikc approach is
recommended to achieve optimal efficacy and minimize side effects. The
combination of paracetamol and slow-release morphine (MST) is effective for
post-surgical pain, but the use of morphine is limited to when it is strictly
necessary. An alternative that is suggested is the combination of paracetamol
with NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as dexketoprofen,
which has a rapid onset of action and a central effect on the central nervous
system
Objective: To compare the effectiveness and safety of
the combination of paracetamol plus dexketoprofen with the combination of
paracetamol plus slow-release morphine (MST) in managing post-cesarean surgical
pain using the ERACS method.
Methods: A double-blind randomized controlled
trial was conducted on post-cesarean patients using the ERACS method during the
period of July-August 2024. A total of 40 patients were recruited using
consecutive sampling and divided into two groups: the paracetamol 750 mg plus
dexketoprofen 25 mg combination group (20 patients) and the paracetamol 750 mg
plus slow-release morphine (MST) 10 mg combination group (20 patients).
Effectiveness was measured by the proportion of patients reporting no pain (VAS
score < 3>.
Results: There was no significant difference in the
proportion of no-pain patients between the group receiving the combination of
paracetamol 750 mg plus dexketoprofen 25 mg and the combination of paracetamol
750 mg plus MST 10 mg, with 18 patients (90%) and 14 patients (70%),
respectively (p-value 0.235). The occurrence of side effects was found only in
the administration of paracetamol plus MST, where 2 patients experienced nausea
and vomiting, and 1 patient experienced dizziness.
Conclusion: The administration of paracetamol plus
dexketoprofen has the same effectiveness as the administration of paracetamol
plus MST in managing post-cesarean surgical pain using the ERACS method and can
be an alternative to replace the administration of paracetamol plus MST if
without contraindication.
Kata Kunci : Nyeri, parasetamol, dexketoprofen, morfin lepas lambat (MST), ERACS