Perbandingan efek anal genetika kombinasi blok paraservikal dan asam mefenamat dengan kombinasi blok paraservikal pada tindakan kuretase

GUNAWAN, Yusva, dr. Hj. Diah Rumekti Hadiati, SpOG(K)

2010 | Tesis | S2 PPDS 1-Obstetri dan Ginekologi

Latar belakang: Anestesi blok paraservikal saat ini merupakan metode anestesi yang sering digunakan untuk tindakan kuretase di RS Sardjito & RS jaringan. Inervasi bagian fundus uteri berbeda dengan inervasi daerah servik uteri, sehingga rasa mulas akibat pelepasan prostaglandin di bagian fundus tidak bisa diblok oleh anestesi blok paraservikal. Menurut kepustakaan penambahan analgetika antiinflamasi non steroid menurunkan intensitas nyeri pada blok paraservikal. Tujuan: Membandingkan intensitas nyeri dan efek samping mual muntah antara penambahan asam mfenamat pada blok paraservikal dibandingkan penambahan plasebo. Rancangan penelitian: Uji klinis secara random (Randomized Clinical Trial) Bahan dan cara: Penelitian dilakukan di RS Dr. Sardjito Jogjakarta dan 4 RS afiliasi sejak Oktober 2009-Desember 2009. Pasien yang memenuhi kriteria inklusi dan eksklusi dibagi menjadi 2 kelompok secara random, yaitu: kelompok perlakuan (asam mefenamat) dan kelompok kontrol (plasebo). Kelompok perlakuan mendapatkan anestesi blok paraservikal dengan lidokain 80 mg dan asam mefenamat 500 mg, kelompok kontrol mendapatkan anestesi blok paraservikal dengan lidokain 80mg dan plasebo. Hasil yang dinilai adalah skor nyeri dan efek samping mual muntah. Skor nyeri diukur dengan menggunakan Wong-Baker FACES Pain Rating Scale. Penilaian skor nyeri dilakukan, saat tindakan kuretase dan 30 menit setelah tindakan kuretase. Data dianalisis dengan Chi-Square dan T-test. Hasil: Didapatkan 160 pasien yang dilakukan kuretase, 80 pasien kelompok perlakuan dan 80 pasien kelompok kontrol. Kedua kelompok sebanding dalam umur, berat badan, paritas, skor kecemasan, pendidikan , indikasi kuret, riwayat kuret dan lama tindakan. Skor nyeri kelompok asam mefenamat lebih rendah secara bermakna dibandingkan kelompok plasebo pada saat tindakan kuretase, 6,40 + 1,69 vs. 7,98 + 1,60 (p=0,00) dan 30 menit setelah tindakan 4,15 + 1,65 vs. 5,30 + 1,88 (p=0,00). Efek samping mual muntah pada kelompok asam mefenamat lebih tinggi dibandingkan dengan kelompok plasebo 16,25% vs. 6,25% (RR 2,6, CI95% 0,97 – 6,95), walaupun secara statistik tidak berbeda bermakna. Kesimpulan: Penambahan asam mefenamat pada blok paraservikal lebih efektif menurunkan rasa nyeri dibandingkan blok paraservikal. Penambahan asam mefenamat pada blok paraservikal meningkatkan efek samping mual muntah.

Background: Paracervical block anesthesia using lidocaine were commonly used in a routine curettage procedure at Dr. Sardjito Hospital Jogjakarta and its sallite hospital. The paracervical block relieves pain in the lower part of the uterus and cervix . It may not be effective for pain originating in the upper part of the uterus, which has a different innervation. Objectives: To compare the rate of pain and side effect of combination paracervical block anesthesia with mefanamic acid and paracervical block anesthesia with placebo. Study Design: A Randomized Controlled Trial Materials and Methods: The study was conducted at Sardjito hospital Jogjakarta and its satellite hospital since October 2009 until December 2009. A total of 160 pasiens meeting the inclusion and exclusion criteria were randomized into two groups, 80 belonged to treatment and 80 to the control group. The treatment group received paracervical block anesthesia and mefenamic acid and the control group received paracervical block anesthesia and placebo. Outcome measured included rate of pain and side effect nausea and vomitus. Pain was measured by Wong –Baker FACES Rating Scale, during curettage and 30 minutes after curettage. Data were analized using Chi square and student T-test. Result: Both groups were comparable in age, body weight, gestational age, anxiety score, education, indication of curettage, history of curettage and duration of procedure. The rate of pain was significant in the mefenamic acid group compare to placebo group during procedure of curettage 6,40 + 1,69 vs. 7,98 + 1,60 (p=0,00) and 30 minutes after curettage 4,15 + 1,65 vs. 5,30 + 1,88 (p=0,00). The side effect of nausea and vomitus were common in mefenamic acid group than placebo group, i.e. 16,25% vs. 6,25% (RR 2,6, CI95% 0,97 – 6,95), but the result were not statistically different. Conclusion: Preoperative administration of mefenamic acid in conjunction with paracervical block anesthesia was effective in reducing pain during and after uterine curettage and was increasing side effect.

Kata Kunci : Asam mefenamat,Blok paraservikal,Kuretase,Nyeri,mefenamic acid, paracervical block anesthesia, uterine curettage, pain