Tesis

Perbedaan Insiden dan Derajat Nyeri Kronik Berdasarkan Lokasi Insisi Kraniotomi Pada Tiga Bulan Pascakraniotomi = Differences in Incidence and Severity of Chronic Pain Based on Craniotomy Incision Site at Three Months Postoperative.

Latar Belakang: Nyeri kronik pascakraniotomi merupakan komplikasi jangka panjang yang berpotensi menurunkan kualitas hidup pasien, namun sering kali luput dari perhatian. Bukti terkini menunjukkan bahwa lokasi insisi kraniotomi dapat memengaruhi kejadian nyeri melalui keterlibatan struktur muskuloskeletal dan periosteum yang berbeda. Kendati demikian, data prospektif yang membahas hubungan ini secara komprehensif masih terbatas, terutama di negara berkembang. Metode: Penelitian kohort prospektif ini melibatkan 120 pasien yang menjalani kraniotomi di dua rumah sakit rujukan nasional di Indonesia. Subjek dikelompokkan berdasarkan lokasi insisi: parietal, temporal, frontal, dan oksipital. Evaluasi nyeri dilakukan tiga bulan pascabedah menggunakan kuesioner BriefPain Inventory (BPI) versi Bahasa Indonesia yang telah divalidasi, mencakup intensitas nyeri dan dampaknya terhadap aktivitas sehari-hari. Analisis statistik mencakup uji Kruskal-Wallis, uji bivariat, dan regresi logistik multivariat untuk mengidentifikasi prediktor nyeri kronik. Hasil: Insiden nyeri kronik pascakraniotomi sebesar 30,8%, tertinggi pada insisi oksipital (46,7%) dan terendah pada insisi parietal (16,7%), meskipun perbedaan ini tidak bermakna secara statistik (p = 0,055). Rerata derajat nyeri tertinggi ditemukan pada kelompok insisi frontal (3,38 ± 1,65) dan oksipital (2,91 ± 1,08). Regresi logistik multivariat menunjukkan bahwa penggunaan analgesia pascaoperatif berbasis opioid (OR = 3,803; 95% IK: 1,47–9,83; p = 0,006) dan insisi oksipital (OR = 1,626; 95% IK: 1,11–4,73; p = 0,013) merupakan prediktor independen kejadian nyeri kronik. Variabel lain seperti teknik intraoperatif, blok kulit kepala, dan status ASA tidak menunjukkan hubungan bermakna. Kesimpulan: Penelitian ini menunjukkan bahwa pemilihan strategi analgesia pascaoperatif dan lokasi insisi kraniotomi memiliki kontribusi penting terhadap risiko terjadinya nyeri kronik. Temuan ini menegaskan perlunya pendekatan individualisasi dalam perencanaan pembedahan dan tata laksana nyeri, guna menurunkan beban jangka panjang nyeri pascakraniotomi pada pasien bedah saraf.
Kata kunci : Kraniotomi; Nyeri Kronik; Nyeri Pascaoperasi; Lokasi Insisi


Background: Chronic postcraniotomy pain (CPP) is a potentially debilitating complication that has gained increasing attention in neurosurgical recovery pathways. Emerging evidence suggests that the location of craniotomy incisions may influence the development of CPP through differential involvement of musculocutaneous and periosteal structures. However, robust prospective data exploring this association remain scarce. Methods: A prospective cohort study was conducted on 120 patients undergoing craniotomy at two tertiary centers in Indonesia. Patients were stratified by incision location: parietal, temporal, frontal, and occipital. Pain outcomes were assessed at three months postoperatively using the Indonesian-validated Brief Pain Inventory (BPI), capturing both intensity and functional interference domains. Bivariate and multivariate logistic regression analyses were used to identify predictors of chronic postcraniotomy pain. Results: The overall incidence of CPP at three months was 30.8%. Incidence by incision site ranged from 16.7% (parietal) to 46.7% (occipital). Mean BPI pain severity scores were highest in frontal incisions (3.38 ± 1.65) and lowest in parietal incisions (2.15 ± 0.65), though differences were not statistically significant (p = 0.280). Multivariate logistic regression identified two independent predictors of CPP: use ofpostoperative opioid-based analgesia (OR = 3.803; 95% CI: 1.47–9.83; p = 0.006) and occipital incision location (OR = 1.626; 95% CI: 1.11–4.73; p = 0.013). Conclusions: This study demonstrates that both postoperative analgesic regimen and anatomical incision site are relevant contributors to the risk of chronic postcraniotomy pain. Notably, the use of opioids and occipital incisions may predispose patients to prolonged nociceptive sequelae. These findings underscore the need for precision analgesia and tailored surgical planning to mitigate long-term pain burden in neurosurgical patients.
Keywords : Craniotomy; Chronic Pain; Postoperative Pain; Incision Site