Tesis

Faktor Prediktor Nyeri Kronik Post-Total Knee Replacement: Analisis terhadap Derajat Nyeri Perioperatif, Indeks Massa Tubuh, dan Teknik Anestesia Regional = Predictive Factors of Chronic Pain for Post-Total Knee Replacement: An Analysis of Perioperative Pain Degree, Body Mass Index, and Regional Anesthesia Techniques.

Pendahuluan: Nyeri kronik post-TKR merupakan komplikasi yang dapat memengaruhi kualitas hidup pasien dan hasil klinis jangka panjang. Faktor-faktor seperti derajat nyeri prabedah dan pascabedah, IMT, serta teknik anestesia regional berperan sebagai prediktor nyeri kronik post-TKR. Meskipun insidensnya cukup tinggi, masih terdapat kontroversi terkait faktor penyebabnya. Selain itu, belum ada penelitian yang secara khusus mengkaji faktor-faktor prediktor nyeri kronik postTKR di Indonesia, khususnya di RSUPNCM. Penelitian ini bertujuan untuk menganalisis hubungan antara faktor-faktor tersebut dengan insidens nyeri kronik post-TKR di RSUPNCM. Metode: Penelitian kohort ambispektif ini menggunakan teknik convenience sampling berdasarkan data pasien yang menjalani pembedahan TKR elektif dari Januari 2021 hingga Maret 2024 di Instalasi Pusat Bedah Terpadu RSUPNCM. Sampel terdiri dari pasien dewasa dengan ASA 1-3 yang menjalani TKR dengan teknik anestesia regional. Pasien dengan riwayat nyeri kronik sebelum TKR, prosedur revisi, dan yang konversi menjadi anestesia umum tidak dimasukkan. Fokus penelitian ini adalah menghitung insidens nyeri kronik post-TKR dan menganalisis faktor prediktornya. Hasil: Sebanyak 37,4% pasien tidak mengalami nyeri kronik post-TKR, sementara 36,3% mengalami nyeri ringan, 20,9% nyeri sedang, dan 5,5% nyeri berat. Derajat nyeri prabedah (OR 9,109; IK95%: 3,122–26,573; p < 0,001) dan nyeri akut pascabedah 24 jam (OR 4,360; IK95%: 1,448–13,126, p = 0,009) berhubungan signifikan dengan kejadian nyeri kronik post-TKR. Tidak ditemukan hubungan yang signifikan antara obesitas dan teknik anestesia regional dengan kejadian nyeri kronik. Simpulan: Derajat nyeri prabedah berat dan nyeri akut pascabedah secara signifikan memengaruhi insidens nyeri kronik post-TKR.
Kata kunci: nyeri kronik, nyeri perioperatif, nyeri prabedah, nyeri pascabedah, indeks massa tubuh, teknik anestesia regional, post-TKR


Introduction: Chronic pain after TKR is a complication that may affect patients' quality of life and long-term clinical outcomes. Factors such as preoperative and postoperative pain levels, BMI, and the options of regional anesthesia techniques serve as predictors for chronic pain after TKR. Although the incidence is relatively high, there is still controversy regarding the factors that contribute to it. Additionally, there has been no study specifically examining the predictors of chronic pain post-TKR in Indonesia, particularly at RSUPNCM. This study aims to analyze the relationship between these factors and the incidence of chronic pain post-TKR at RSUPNCM. Methods: This ambispective cohort study uses convenience sampling based on data from patients who underwent elective TKR surgeries from January 2021 to March 2024 at the Instalasi Pusat Bedah Terpadu of RSUPNCM. The sample consisted of adult patients with ASA classifications 1-3 who underwent TKR with regional anesthesia techniques. Patients with a history of chronic pain before TKR, revision procedures, or those converted to general anesthesia during the surgery were excluded. This study focuses on calculating the incidence of chronic pain post-TKR and analyzing its predictors. Results: 37.4% of the patients did not experience chronic pain post-TKR, while 36.3% had mild pain, 20.9% had moderate pain, and 5.5% had severe pain. The degree of preoperative pain (OR 9.109; 95% CI: 3.122–26.573; p < 0.001) and acute postoperative pain within 24 hours (OR 4.360; 95% CI: 1.448–13.126, p = 0.009) were significantly associated with the occurrence of chronic pain post-TKR. No significant relationship was found between obesity and the regional anesthesia technique with the incidence of chronic pain. Conclusion: Severe preoperative pain levels and acute postoperative pain significantly influence the incidence of chronic pain post-TKR.
Keywords: chronic pain, perioperative pain, preoperative pain, postoperative pain, body mass index, regional anesthesia techniques, post-TKR