PERBANDINGAN EFEK ANALGETIKA ANTARA KOMBINASI BLOK PARASERVIKAL DAN DIAZEPAM DENGAN BLOK PARASERVIKAL SAJA PADA TINDAKAN KURETASE

Karinda Dwiworo Harumsiwi, dr. R. Detty S.Nurdiati MPH,PhD,SpOG (K)

2013 | Tesis | S2 Ilmu Kebidanan dan Penyakit Kandungan

Latar belakang: Kuretase merupakan tindakan operatif minor yang banyak dilakukan di bidang Obstetri dan Ginekologi. Nyeri yang ditimbulkan oleh tindakan kuretase merupakan refleksi individu terhadap berbagai rangsangan yang diterima dan diinterpretasikan berbeda-beda dipengaruhi oleh emosi, motivasi, kognitif, sosial dan budaya. Beberapa teknik anestesi dikombinasikan dengan pemberian medikamentosa lain diteliti untuk mengatasi nyeri. Diazepam yang memiliki meningkatkan efek GABA, sedatif dan hipnotik, dalam penelitian ini dikombinasikan dengan blok paraservikal. Tujuan penelitian Membandingkan intensitas nyeri dan efek samping antara penambahan diazepam 10 mg pada anestesi blok paraservikal dibandingkan hanya dengan blok paraservikal pada tindakan kuretase Metode: Penelitian secara randomised control trial. Dilaksanakan di RSUP Dr. Sardjito dan RSUD Panembahan Senopati Bantul selama 6 bulan sejak Agustus 2011. Subyek yang memenuhi kriteria inklusi dibagi menjadi dua kelompok (blok paraservikal dan diazepam vs blok paraservikal). Kecemasan diukur dengan State Trait Anxiety Inventory (STAI). Nyeri diukur dengan Wong-baker FACES Pain Rating Scale. Faktor yang diduga berpengaruh dianalisis dengan uji T-test dan Chi-square. Hasil: Terdapat 60 pasien yang mengikuti penelitian ini. Pemberian diazepam 10 mg dikombinasikan dengan blok paraservikal didapatkan skor nyeri lebih rendah. Perbedaan rerata skor nyeri antara kedua kelompok sebesar -1,800 (p=0,001). Variabel yang turut dianalisa antara lain usia, BMI, tingkat pendidikan, skor kecemasan, lama tindakan dan paritas. Hanya skor kecemasan yang memiliki perbedaan bermakna (p=0,015). Setelah dilakukan uji lanjut didapatkan skor kecemasan(p=0,003) dan jenis anestesi dengan atau tanpa diazepam (p=0,001), keduanya berbeda bermakna terhadap skor nyeri. Kesimpulan: Didapatkan perbedaan bermakna antara skor kecemasan dan jenis anestesi (blok paraservikal vs blok paraservikal dan diazepam 10 mg) terhadap skor nyeri pada tindakan kuretase.

Background: Curettage is a minor operation that mostly done in the field of Obstetrics and Gynecology. Pain caused by the actions of curettage is an individual reflection to various stimuli, received and interpreted differently influenced by emotional, motivational, cognitive, social and cultural rights. Several anesthetic techniques combined with the provision of other Medical studied for pain. Diazepam has increased GABA effect, sedatives and hypnotics, in this study combined with paracervical block. Aim of study: To compare the intensity of pain and side effects the addition of diazepam 10 mg to paracervical block anesthesia with paracervical block only in curettage. Design and method: Randomised controlled trial research conducted in Dr. Sardjito hospital and Panembahan Senopati Bantul District Hospital, which lasted for six months from August 2011. Subjects who met the inclusion criteria were divided into two groups (paracervical block and diazepam 10 mg;paracervical block). Anxiety level was measured with the State Trait Anxiety Inventory (STAI). Pain level was measured by the Wong-Baker FACES Pain Rating Scale. Factors suspected to affect the pain level were analyzed by t-tests and Chi-square. Result: There were 60 patients in this study. Provision of diazepam 10 mg in combination with paracervical block has result in obtained lower pain scores. Differences in mean pain scores between the two groups is -1.800 (p = 0.001). Variables that also analyzed such as age, BMI, education level, anxiety scores, length of action and parity. Only the score of anxiety that has a significant difference (p = 0.015). After further testing obtained scores of anxiety (p = 0.003) and type of anesthesia, with or without diazepam (p = 0.001), both significantly difference to pain level. Conclusion: It was found significant differences between the scores of anxiety and type of anesthesia (paracervical block versus paracervical block and diazepam 10 mg) to pain scores on curettage.

Kata Kunci : kuretase, diazepam, skor kecemasan, skor nyeri