Tesis

Efek Penambahan MgSO4 Intravena 30mg/kgBB Pada Ketorolak Terhadap Derajat Nyeri dan Kebutuhan Opioid Pascabedah Ortopedi Ekstremitas Bawah = Effects of Additional Intravenous MgSO4 30mg/kgBW and Ketorolac: Study to Assess Pain and Opioid Consumption in Post Lower Extremity Orthopedic Surgery.

Latar Belakang: Nyeri pascabedah ortopedi merupakan nyeri yang memiliki derajat cukup tinggi. Penelitian di RSCM sebelumnya bahwa nyeri pascabedah ortopedi ekstremitas bawah merupakan nyeri dengan intensitas tinggi meskipun sudah diberikan analgesia tunggal. NSAID sebagai analgesia tunggal dinilai belum efektif. Magnesium sulfat dapat dijadikan alternatif tambahan analgesia melalui jalur N-Metil D-Aspartat (NMDA) yang berfungsi menghambat sensitisasi nyeri sentral. Penelitian ini bertujuan untuk menilai efek pemberian magnesium sulfat 30mg/kgBB pada ketorolak terhadap derajat nyeri dan kebutuhan opioid pascabedah ortopedi ekstremitas bawah Metode: Penelitian ini merupakan uji klinis acak tersamar ganda yang melibatkan 60 pasien yang menjalani operasi ekstremitas bawah. Subjek dibagi menjadi dua kelompok yaitu kelompok perlakuan yang mendapat tambahan magnesium sulfat 30mg/kgBB pada ketorolak, dan kelompok yang mendapat ketorolak dan plasebo. Dilakukan pencatatan derajat nyeri pascabedah jam ke 0, 6, 12 dan 24 jam, kebutuhan opioid pascabedah, serta efek samping pascapemberian sediaan. Hasil: Derajat nyeri pascabedah menurun pada kelompok perlakuan. Kebutuhan opioid pascabedah juga menurun pada kelompok perlakuan. Efek samping mual, muntah, nyeri ulu hati, aritmia jantung tidak terjadi pascapemberian. Terdapat 4 pasien yang mengalami hipotensi pascainduksi dan dapat diatasi dengan pemberian vasopressor Simpulan: Magnesium sulfat memiliki pengaruh terhadap ketorolak dalam mengurangi derajat nyeri pascabedah, dan kebutuhan opioid pascabedah ortopedi ekstremitas bawah.
Kata Kunci: Magnesium sulfat, ketorolak, operasi ekstremitas bawah, derajat nyeri pascabedah, Kebutuhan opioid pascabedah


Background: Orthopedic postoperative often produce unpleasant experience for the patients because of its high intensity. Previous research at RSCM stated that postoperative pain in orthopedic surgery classified as an high intensity pain evethough single analgesia has been given. NSAIDs as a single analgesia are considered not effective. Magnesium sulfate can be used as an additional alternative for analgesia adjuvant through the N-Methyl D-Aspartate (NMDA) pathway which functions to inhibit central pain sensitization. This study aims to assess the effect of giving ketorolac 30 mg/kg BW magnesium sulfate on the degree of pain and opioid consumption after orthopedic lower extremity surgery. Methods: This study was a randomized, double-blind clinical trial involving 60 patients undergoing lower extremity surgery. Subjects were divided into two groups: the treatment group that received additional magnesium sulfate 30 mg/kgBB and ketorolac, and the control group that received ketorolac and placebo. The degree of postoperative pain was assessed at 0, 6, 12 and 24 hours, also 24 hour post operative opioid consumption, and the side effects after administration of magnesium sulfate. Result: The degree of postoperative pain decreased in the treatment group. Postoperative opioid consumption also decreased in the treatment group. Side effects of nausea, vomiting, heartburn, cardiac arrhythmia did not occur after administration. There were 4 patients who experienced post-induction hypotension and could be treated with vasopressors Conclusion: Magnesium sulfate has an effect on ketorolac in reducing the degree of postoperative pain, and the opioid consumption in orthopedic lower extremity surgery.
Keywords: Magnesium sulfate, ketorolac, lower extremity surgery, postoperative pain, postoperative opioid consumption.