Perbandingan Efek Analgesi Infiltrasi Morfin 10 Mg dan Bupivakain 0,5% 2 Mg/KgBB pada Seksio Sesarea dengan Teknik Anestesi Spinal

  • Wulan Fadinie Anesthesiology
  • Dadik Wahyu Wijaya Faculty of Medicine Universitas Sumatera Utara Medan
  • Hasanul Arifin Faculty of Medicine Universitas Sumatera Utara Medan
Keywords: anestesi spina, analgesi pascaoperasi, bupivakain, morfin, seksio sesarea, spinal anesthesia, bupivacaine, cesarean section, morphine, postoperative pain

Abstract

Latar Belakang: Persalinan dengan seksio sesarea sangat umum dilakukan dan setiap intervensi yang dapat mengurangi rasa sakit pasca operasi layak diteliti lebih lanjut. Cara terbaik untuk mengurangi rasa sakit dengan memberikan analgesi yang langsung bekerja pada area luka. Telah diketahui morfin memiliki reseptor perifer sehingga pemberian secara subkutan dapat menjadi metode yang sangat efektif dalam manajemen nyeri pasca operasi
Tujuan: Membandingkan efek analgesi dari infiltrasi lokal morfin 10 mg dengan bupivakain 2mg/kgBB 0,5% pada pasca seksio sesarea dengan anestesi spinal.
Subjek dan Metode: Penelitian ini adalah uji klinis acak tersamar ganda dengan 100 sampel wanita hamil, usia 20-40 tahun, PS-ASA I-II yang akan menjalani seksio sesarea elektif dan darurat dengan anestesi spinal. Setelah dihitung secara statistik, sampel dibagi secara acak menjadi 2 kelompok. Kelompok pertama mendapat morfin 10 mg dan kelompok kedua mendapat bupivakain 0,5% 2 mg/kgBB secara infiltrasi lokal subkutan didaerah luka operasi. Skala nyeri dinilai dengan VAS. Hasilnya diuji dengan uji T-independent, Chi-Square, dengan nilai signifikan 95% (p <0,05%, signifikan secara statistik).
Hasil: Pada kelompok morfin pemberian analgesi tambahan lebih sedikit daripada kelompok bupivakain, hasilnya berbeda bermakna secara statistik (p <0.05) pada setiap jam pengamatan. Efek samping tidak ditemukan pada kedua kelompok. Kelompok morfin meringankan rasa sakit lebih baik daripada kelompok bupivakain dengan skor VAS yang lebih rendah pada setiap jam pengamatan
Simpulan: Infiltrasi lokal subkutan 10 mg morfin memberikan efek analgetik yang lebih baik pada pasien pasca seksio sesarea dengan anestesi spinal dibandingkan dengan bupivacain 0,5% 2 mg/kgBB, tanpa efek samping.

Comparison of the Analgesic Effects of 10 mg Morphine and 2mg/BW Bupivacaine 0.5% Infiltration in Cesarean Section with Spinal Anesthesia Technique

Abstract

Background: Nowadays, deliveries by cesarean section are more commonly done, any intervention that can make progression to reduce post-operative pain are feasible for further study. The best way to reduce pain is by administration pain relieve drug that directly act in wound. It is known that morphine has peripheral receptors, so subcutaneous administration can be a very effective method of postoperative pain management.
Objective: To compare analgetic effect from local infiltration of 10 mg morphine with 2mg/BW bupivacaine 0.5% in post cesarean section with spinal anesthesia
Subject and Methods: This study was done by double blinded randomized clinical trial with 100 samples of pregnant women, age 20-40 years, PS-ASA I-II that will undergo elective and emergency cesarean section with spinal anesthesia. After calculated statistically, all samples divided randomly into 2 groups. First group got morphine 10 mg and second group got bupivacaine 0.5% 2 mg/BW infiltration at the area of surgical wound. Pain scale was evaluated by VAS. The result was tested by T-independent test, Chi-Square, with significant value 95% (p<0.05%, statistically significant).
Result: In morphine group, the additional analgesia was less than bupivacaine group, the results were statistically significant (p <0.05) at each hour of observation. No side effects were found in either group. The morphine group relieved pain better than the bupivacaine group with lower VAS scores at each hour of observation.
Conclusion: Infiltration of 10 mg morphine subcutaneous compared to bupivacaine 0.5% 2mg/BW give better analgetic effect in post cesarean section patients with spinal anesthesia, without any side effects

Author Biographies

Dadik Wahyu Wijaya, Faculty of Medicine Universitas Sumatera Utara Medan

Departement Anesthesiology and Intensive Care General Hospital H. Adam Malik Medan

Hasanul Arifin, Faculty of Medicine Universitas Sumatera Utara Medan

Departement Anesthesiology and Intensive Care General Hospital H. Adam Malik Medan

References

Ebirim LN, Buowaro OY, Ghosh S.Pain in Perspective.Rijeka: Intech; 2012.http://www.intechopen.com/books/pain-in-perspective/physical-and-psychological-aspects-of-pain-in-obstetrics.

Penn, Z. Ghaem-Maghami, S. Indications for Caesarean Section. Best Practice & Research Clinical Obstetrics & Gynaecology 2001;15(1):1–15.

Leung A. Y. Postoperative pain management in obstetric anesthesia-new challenges and solutions. J Clin Anesth 2004 Feb;16(1):57–65.

Stein C. Opioids in pain control: basic and clinical aspects. Cambridge University Press. 1999; 5:96–105.

Kvolik S, Kristek J, Takac I, Gulam D. A wound infiltration as a method of postoperative analgesia. Period Biol 2009; 111(2): 241–6.

Stein C. Peripheral opioid receptors: a new therapeutic concept to target inflammation.http://www.pasteur.fr/applications/euroconf/digestivediseases/1 7Steinabstract.pdf

Mehta TR, Parikh BK, Bhosale GP, Butals BP, Shah VR. Post operative analgesia after incisional infiltration of bupivacaine vs bupivacaine with buprenorphine.J Anaesthesiol Clin Pharmacol 2011; 27(2):211–4.

Modaress-Nejad V, Motamedi B, Nafissy M. The Comparison of pain relief between postoperative wound infiltrations with bupivacaine 0.5% combined with epinephrine after cesarean section. Zahedan J Res Med Sci 2013 Apr; 15(4):17-20.

Jabameli M, Safavi M, Honarnand A, Saryazdi, Moradi D, Kashefi P. The comparison of intraincisional injection tramadol, pethidin and bupivacaine on postcesarean section pain relief under spinal anesthesia. Adv Biomed Res. 2012; 1:53.

Onutu AH, Ioana MI, Todor A, Lucaciu D O, Acalovshu I. Wound infiltration with 1% pethidine provides an opioid-sparing effect after uncemented total hip arthroplasty: a prospective randomized study. J Rom Anest Terap Int2012; 19:5-12.

Chander R, Liddle D, Kaur B, Varghese M. Wound infiltration with plain bupivakain as compared with bupivacaine fentanyl mixture for postoperative pain relief after abdominal surgery. Anesthesia: Essay and Research2011; 5(2):142-6.

Karaman S, Kocabas S, Sedat E, Firat V, Uyar M, Sendag F. Intraperitoneal ropivacaine or ropivacaine plus meperidine for laparoscopic gynecoligal procedures. Agri 2012;24(2):56–62.

Zyczkowska J, Wordliczek J. Subcutaneous and intravenous administration of analgesics in palliative medicine. Adv Pall Med 2009; 8, 4:153–60.

Published
2020-09-17
Section
Articles