Tesis

Pengaruh Lidokain Intravena Kontinyu Intraoperatif terhadap Luaran Pascabedah Kraniotomi: Kajian Terhadap Nyeri Pascabedah, Kadar TNF Alfa dan Lama Rawat = The Effects of Intraoperative Continuous Intravenous Lidocaine on Postoperative Craniotomy Outcomes: A Study on Postoperative Pain, TNF Alpha Levels and Hospitalization Duration.

Latar belakang: Proses pembedahan seperti kraniotomi mengakibatkan inflamasi yang dimulai sejak awal insisi yang juga berpengaruh dengan kejadian nyeri pascabedah. Kedua hal ini kemudian berpengaruh terhadap lama rawat pasien. Lidokain intravena intraoperatif memiliki efek analgesik dan antiinflamasi dan telah terbukti efektif sebagai ajuvan dalam manajemen nyeri pascabedah pada pembedahan abdominal. Penelitian ini bertujuan untuk meneliti pengaruh pemberian lidokain intravena kontinyu intraoperatif kraniotomi terhadap nyeri pascabedah, TNF-α, dan lama rawat. Metode: Randomized controlled trial ini menggunakan pengambilan sampel secara consecutive sampling. Sebanyak 50 subjek penelitian dengan tumor otak yang menjalani kraniotomi. Kelompok terapi diberikan lidokain (2%) intravena bolus 1,5 mg/kg saat induksi dilanjutkan rumatan 2 mg/kg/jam, kelompok kontrol diberikan NaCl 0,9% dengan volume yang sama. Luaran yang dinilai adalah nyeri pascabedah, kadar TNF-α, dan lama rawat. Hasil: Terdapat perbedaan bermakna skor NPS 1 jam pascabedah, NPS 6 jam pascabedah, dan NPS 24 jam pascabedah antara kelompok terapi dengan kontrol (p < 0,001). Terdapat perbedaan selisih kadar TNF-α prainduksi dengan 1 jam pascabedah (p = 0,001) yang bermakna namun tidak terdapat selisih kadar TNF-α prainduksi dengan 24 jam (p = 0,334) pascabedah yang bermakna antara kelompok terapi dan kontrol. Tidak ada perbedaan bermakna lama rawat antara kelompok terapi dan kontrol Simpulan: Pemberian lidokain intravena kontinyu intraoperatif dibandingkan plasebo pada kraniotomi berpengaruh terhadap nyeri pascabedah dan kadar TNF-α namun tidak berpengaruh terhadap lama rawat.
Kata Kunci: lidokain intravena, kraniotomi, nyeri pascabedah, TNF-α, lama rawat


Background: Surgery such as craniotomy causes inflammation which also affects the incidence of postoperative pain. These two things then affect the length of stay of the patient. Intraoperative continuous intravenous lidocaine has analgesic and anti-inflammatory effects and has been shown to be effective as an adjuvant in the management of postoperative pain in abdominal surgery. This study aims to investigate the effects of the administration of intraoperative continuous intravenous lidocaine during craniotomy on postoperative pain, TNF-α, and length of hospital stay. Methods: This randomized controlled trial uses consecutive sampling method. A total of 50 subjects with brain tumors underwent craniotomy. The therapy group was given lidocaine (2%) intravenous bolus 1.5 mg/kg at induction followed by maintenance at 2 mg/kg/hour, the control group was given NaCl 0.9% with the same volume. The outcomes assessed were postoperative pain, TNF-α levels, and length of hospital stay. Results: There was a significant difference in NPS 1-hour postoperative, 6-hour postoperative NPS, and 24-hour postoperative NPS scores between the treatment group and the control group (p < 0.001). There was a significant difference between pre-induction TNF-α levels and 1 hour postoperatively (p = 0.001) however there was no significant difference in pre-induction TNF-α levels with 24 hours (p = 0.334) postoperatively between the treatment and control groups. There was no significant difference in length of hospital stay between the therapy and control groups. Conclusions: Intraoperative continuous intravenous lidocaine administration compared to placebo at craniotomy had an effect on postoperative pain and TNF-α levels but had no effect on length of hospital stay.
Keywords: intravenous lidocaine, craniotomy, postoperative pain, TNF-α, hospitalization duration