Tesis

Preemptif Analgesia Pada Total Knee Arthroplasty Perbandingan Efek Pemberian Dosis Tunggal Kombinasi Celecoxib Dan Pregabalin Dengan Dosis Pengulangan Kombinasi Celecoxib dan Pregabalin (Uji Klinis Acak Tersamar Ganda) = Preemptive analgesia in total knee arthroplasty: Comparing the effects of single dose combined celecoxib with pregabaline and repetition dose combined celecoxib with pregabaline (double blind controlled clinical trial) .

Pendahuluan: Keluhan nyeri paska total knee arthroplasty dilaporkan cukup tinggi sehingga meningkatkan penggunaan morfin paska operasi, memperlambat mobilisasi, meningkatkan biaya dan menurunkan angka kepuasan dari pasien. Berbagai metode analgesia diteliti untuk mendapatkan metode analgesia yang efektif, kurang efek samping, dan mudah di aplikasikan kepada pasien. Preemptif analgesia Celecoxib dan Pregabalin dilaporkan memberikan hasil yang menjanjikan, namun belum banyak studi yang melaporkannya Metode: Penelitian ini merupakan uji klinis acak tersamar ganda yang dilakukan kepada 30 subjek penelitian. Sebanyak 30 pasien yang memenuhi kriteria inklusi dibagi secara acak kedalam 3 kelompok perlakuan. Kelompok pertama mendapatkan preemptif analgesia kombinasi Celecoxib 400 mg dan Pregabalin 150 mg dosis tunggal, diberikan 1 jam pre operasi, Kelompok 2 kedua mendapatkan preemptif analgesia kombinasi Celecoxib 200 mg dan pregabalin 75 mg yang diberikan 2 kali per hari, 3 hari sebelum operasi, dan kelompok 3 diberikan placebo. Prosedur operasi dilakukan oleh satu orang orthopaedi dan induksi anastesi dilakukan satu orang anastesiologi. Efektifitas uji ini di nilai dengan menghitung Total konsumsi morfin paska operasi, penilaian skala nyeri dengan Visual Analog Scale (VAS), latihan fungsional lutut yang diukur dengan range of motion (ROM) dan mobilisasi paska operasi. Hasil: Terdapat perbedaan bermakna total konsumsi morfin paska operasi pada kelompok yang mendapatkan preemptif analgesia, dibandingkan placebo, tapi tidak berbeda bermakna antara kedua kelompok pemberian preemptif analgesia. Terdapat perbedaan bermakna, kadar VAS antara kelompok yang mendapatkan preemptif analgesia dibanding kelompok placebo, tapi tidak terdapat perbedaan bermakna antara kedua kelompok pemberian preemptif analgesia. Tidak terdapat perbedaan bermakna antara ketiga kelompok perlakuan pada penilaian range of motion dan mobilisasi paska operasi. Keluhan mual ditemukan pada 2 subjek di kelompok 1, 1 subjek di kelompok 2 dan 1 subjek di kelompok 3 Diskusi: Pemberian preemptif analgesia celecoxib dan pregabalin efektif mengurangi nyeri akut paska operasi dan menurunkan penggunaan morfin paska operasi, Meski demikian tidak ditemukan perbedaan antara kedua metode yang diuji, terutama dalam mengatasi nyeri saat bergerak. Di anjurkan untuk menggunakan kombinasi celecoxib dan pregabalin sebagai preemptif analgesia pada prosedur total knee arthroplasty
Kata kunci: Preemptif analgesia, celecoxib, pregabalin, morfin, VAS


Introduction: The incidence of pain after total knee arthroplasty reported high enough to increase the use of postoperative morphine, slow down mobilization, delaying discharge planning, increase costs and decrease the rate of patient satisfaction. Various methods of analgesia studied to obtain an effective method, less side effects, and easily applied to the patient. Combination celecoxib preemptive analgesia and Pregabalin reported promising results, but the research was limited. Methods: This study is a randomized double blind controlled clinical trial conducted at 30 research subjects. A total of 30 patients who met the inclusion criteria were randomly divided into 3 treatment groups. The first group to get a preemptive analgesia combination Celecoxib 400 mg and Pregabalin 150 mg single dose was given 1 hour pre operation, second group get preemptive analgesia combination Celecoxib 200 mg and pregabalin 75 mg given 2 times a day, 3 days before surgery, and the third group is a placebo. The surgical procedure is performed by a single person orthopedic surgeon and induction of anesthesia is done by one person Anesthesiology, The effectiveness of this test in value by calculating the total consumption of morphine after surgery, assessment pain scale with the Visual Analog Scale (VAS), the exercise of functional knee as measured by range of motion (ROM) and mobilization postoperatively. Result: There are significant differences in the total morphine consumption postoperatively in the group receiving preemptive analgesia, compared to placebo, but there was no significant difference between the two methods of administration of preemptive analgesia. There are significant differences, the levels of VAS between the groups who received preemptive analgesia compared to the placebo group, but not significantly different between the two groups of granting preemptive analgesia. There was no significant relationship between the three treatment groups on the assessment of range of motion and postoperative mobilization. Complaints such as nausea found in 2 subjects in group 1, 1 subject in group 2, and 1 subject in group 1 Discussions: Administration of preemptive analgesia has a significant effect to reduce the use of morphine after surgery and decrease postoperative pain. However, the study did not find significant differences between the two methods of administration of preemptive analgesia. We strongly recommend to use of a combination of celecoxib and pregabalin as a preemptive analgesia in total knee arthroplasty procedure
Keywords: preemptive analgesia, celecoxib, pregabalin, morphine, vas