Luaran Terapi Berdasarkan Jenis Pemberian Analgetik pada Pasien Pasca Operasi Ortopedi

https://doi.org/10.22146/jmpf.53313

Nurul Irna Windari(1), Zullies Ikawati, Apt.(2*), Eni Purwaningtyastuti(3)

(1) Graduate Program of Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada
(2) Graduate Program of Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada
(3) Instalasi Farmasi RSUP Dr. Sardjito, Yogyakarta
(*) Corresponding Author

Abstract


Postoperative pain was suffered by 80% of the total patients. One of the many surgical procedures performed is orthopedics. Ketorolac and fentanyl are often used for postoperative orthopedic pain. Appropriate postoperative pain management with adequate analgesic administration will accelerate pain reduction and shorten the patient's hospital stay. This study aims to determine the difference in the effect of continuous fentanyl and intravenous ketorolac on pain targets achievement and Length of Stay (LOS) of patients after orthopedic surgery. This study is a prospective cohort study, involving inpatients after orthopedic surgery in Dr. Sardjito Yogyakarta in July-October 2019. The independent variable is continuous fentanyl and intravenous ketorolac, while the dependent variable is the achievement of pain targets and LOS. The analysis was conducted by Fisher's exact test, Mann Whitney's test, and multivariate analysis to determine the dominance of variables on the research outcomes. There were 59 patients after orthopedic surgery in this study. A total of 34 patients in the continuous fentanyil group and 25 patients in the intravenous ketorolac group. There was no difference in the effect of continuous fentanyl administration and intravenous ketorolac on pain targets achievement (P = 0.711), while there were differences in the effect of continuous fentanyl administration and intravenous ketorolac on the average LOS of patients in the hospital (P = 0,000). Continuous fentanyl and intravenous ketorolac can both produce the achievement of adequate postoperative orthopedic pain targets, but the mean LOS becomes shorter in patients with intravenous ketorolac.

Keywords


Continuous fentanyl; intravenous ketorolac; orthopedic postoperative pain; pain target achievement; LOS

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References

  1. Misiołek H, Cettler M, Woroń J, Wordliczek J, Dobrogowski J, Mayzner-Zawadzka E. The 2014 guidelines for post-operative pain management. Anaesthesiol Intensive Ther. 46(4):221-244. doi:10.5603/AIT.2014.0041
  2. Lestari YED. Pengaruh Rom Exercise Dini Pada Pasien Post Operasi Fraktur Ekstremitas Bawah (Fraktur Femur Dan Fraktur Cruris) Terhadap Lama Hari Rawat Di Ruang Bedah Rsud Gambiran Kota Kediri. J Ilmu Kesehat. 2017;3(1):34. doi:10.32831/jik.v3i1.43
  3. Otten R, van Roermund PM, Picavet HSJ. Trends in the number of knee and hip arthroplasties: considerably more knee and hip prostheses due to osteoarthritis in 2030. Ned Tijdschr Geneeskd. 2010;154(20).
  4. Putra A, Kumala I, Ramadhan MA, Mutiara C. Perbandingan Perhitungan Numeric Rating Scale pada Pasien Osteoartritis Sendi Lutut Pre dan Post Total Knee Replacement di RS. Urip Sumoharjo Kota Bandar Lampung Tahun 2015-2016 | Putra | Jurnal Kedokteran Universitas Lampung. J Kedokt Unila. 2018;2(2):68-76. http://juke.kedokteran.unila.ac.id/index.php/JK/article/view/1940. Accessed January 1, 2020.
  5. Setiani D. Identifikasi Tingkat Kecemasan Pre Operasi Pasien Fraktur di Ruang Aster dan Cempaka RSUD Abdul Wahab Sjahranie Samarinda. J Ilmu Kesehat. 2017;5(2):83-87. doi:10.30650/jik.v5i2.55
  6. Handayani S, Arifin H, Manjas M. Kajian penggunaan analgetik Pada Pasien Pasca Bedah Fraktur di Trauma Centre RSUP M. Djamil Padang. JSFK (Jurnal Sains Farm Klin. 2019;6(2):113-120. doi:10.25077/JSFK.6.2.113-120.2019
  7. Misiran K Bin, Yahaya LSB. The effectiveness of patient-controlled epidural analgesia with ropivacaine 0.165% with fentanyl 2.0 miroc g/ml or levobupivacaine 0.125% with fentanyl 2.0 micro g/ml as a method of postoperative analgesia after major orthopaedic surgery. Middle East J Anaesthesiol. 2013;22(1):59-64. http://www.ncbi.nlm.nih.gov/pubmed/23833852. Accessed January 1, 2020.
  8. Privado MS, Issy AM, Lanchote VL, Garcia JBS, Sakata RK. Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial. Sao Paulo Med J. 2010;128(1):5-9. doi:10.1590/s1516-31802010000100002
  9. Sawhney KY, Kundra S, Grewal A, Katyayal S, Singh G, Kaur A. A randomized double blinded comparison of epidural infusion of bupivacaine, ropivacaine, bupivacaine-fentanyl, ropivacaine-fentanyl for postoperative pain relief in lower limb surgeries. J Clin Diagnostic Res. 2015;9(9):UC19-UC23. doi:10.7860/JCDR/2015/15157.6459
  10. Noegroho W, Uyun Y, Widodo U. Jurnal Komplikasi Anestesi. J Komplikasi Anestesi. 2017;5(1):1-10. http://anestesi.fk.ugm.ac.id/jka.ugm/jurnal_detail.php?id=133. Accessed January 2, 2020.
  11. Parsons B, Schaefer C, Mann R, et al. Economic and humanistic burden of post-trauma and post-surgical neuropathic pain among adults in the United States. J Pain Res. 2013;6:459-469. doi:10.2147/JPR.S44939
  12. Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11(12):1859-1871. doi:10.1111/j.1526-4637.2010.00983.x
  13. Vadivelu N, Gowda AM, Urman RD, et al. Ketorolac tromethamine - Routes and clinical implications. Pain Pract. 2015;15(2):175-193. doi:10.1111/papr.12198
  14. Moghaddam MRG, Ganjifard M, Ghasemi S. Effects of ketorolac versus pethidine on the management of postoperative acute pain and complications after hemorrhoidectomy. J Surg trauma. 2019;7(2):48-54. doi:10.32592/jsurgery.2019.7.2.102
  15. Schwinghammer AJ, Isaacs AN, Benner RW, Freeman H, O’Sullivan JA, Nisly SA. Continuous Infusion Ketorolac for Postoperative Analgesia Following Unilateral Total Knee Arthroplasty. Ann Pharmacother. 2017;51(6):451-456. doi:10.1177/1060028017694655
  16. Shaffer EE, Pham A, Woldman RL, et al. Estimating the Effect of Intravenous Acetaminophen for Postoperative Pain Management on Length of Stay and Inpatient Hospital Costs. Adv Ther. 2017;33(12):2211-2228. doi:10.1007/s12325-016-0438-y
  17. Eladi IA, Mourad KH, Youssef AN, Abdelrazek AA, Ramadan MA. Efficacy and safety of intravenous ketorolac versus nalbuphine in relieving postoperative pain after tonsillectomy in children. Open Access Maced J Med Sci. 2019;7(7):1082-1086. doi:10.3889/oamjms.2019.243
  18. Özer S, Yurk HS. Evaluatıon Of Anaesthetic And Analgesic Effects Of Intrathecal Tramadol Vs Fentanyl Administration. SiSli Etfal Hastan Tip Bul / Med Bull Sisli Hosp. 2019;53(1):16-20. doi:10.14744/semb.2018.19327
  19. Banerjee S, Pattnaik SK. A comparative study between epidural butorphanol, nalbuphine, and fentanyl for post-operative analgesia in lower abdominal surgeries. Asian J Pharm Clin Res. 2017;10(5):383-388. doi:10.22159/ajpcr.2017.v10i5.16802
  20. Solanki RN, Gosai ND, Joshi GM, Patel BM, Modi H V, Jain R. A Comparative Study of Intravenous Nalbuphine HCl and Tramadol HCl for PostOperative Pain Relief Following Orthopaedic Surgeries. Asian Pacific J Heal Sci. 2015;2(1):155-160. doi:10.21276/apjhs.2015.2.1.26
  21. Yousef AAAM, Atef AM, Awais WM. Comparison of fentanyl versus meperidine as supplements to epidural clonidine-bupivacaine in patients with lower limb orthopedic surgery under combined spinal epidural anesthesia. BMC Anesthesiol. 2015;15(1). doi:10.1186/s12871-015-0126-5
  22. Rakhshan V. Common risk factors for postoperative pain following the extraction of wisdom teeth. J Korean Assoc Oral Maxillofac Surg. 2015;41(2):59. doi:10.5125/jkaoms.2015.41.2.59
  23. Abrams TE, Vaughan-Sarrazin M, Rosenthal GE. Influence of psychiatric comorbidity on surgical mortality. Arch Surg. 2010;145(10):947-953. doi:10.1001/archsurg.2010.190
  24. Garcia AE, Bonnaig J V., Yoneda ZT, et al. Patient variables which may predict length of stay and hospital costs in elderly patients with hip fracture. J Orthop Trauma. 2012;26(11):620-623. doi:10.1097/BOT.0b013e3182695416
  25. Gruskay JA, Fu M, Bohl DD, Webb ML, Grauer JN. Factors affecting length of stay after elective posterior lumbar spine surgery: A multivariate analysis. Spine J. 2015;15(6):1188-1195. doi:10.1016/j.spinee.2013.10.022
  26. Khosravizadeh O, Vatankhah S, Bastani P, Kalhor R, Alirezaei S, Doosty F. Factors affecting length of stay in teaching hospitals of a middle-income country. Electron physician. 2016;8(10):3042-3047. doi:10.19082/3042
  27. Susetyowati S, Ija M, Makhmudi A. Status gizi pasien bedah mayor preoperasi berpengaruh terhadap penyembuhan luka dan lama rawat inap pascaoperasi di RSUP Dr Sardjito Yogyakarta. J Gizi Klin Indones. 2010;7(1):1. doi:10.22146/ijcn.17608
  28. Hearn L, Derry S, Moore RA. Single dose dipyrone (metamizole) for acute postoperative pain in adults. Cochrane Database Syst Rev. 2016;2016(4). doi:10.1002/14651858.CD011421.pub2
  29. Moore RA, Derry S, Wiffen PJ, Straube S, Aldington DJ. Overview review: Comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions. Eur J Pain (United Kingdom). 2015;19(9):1213-1223. doi:10.1002/ejp.649
  30. Banka TR, Ruel A, Fields K, YaDeau J, Westrich G. Preoperative Predictors of Postoperative Opioid Usage, Pain Scores, and Referral to a Pain Management Service in Total Knee Arthroplasty. HSS J. 2015;11(1):71-75. doi:10.1007/s11420-014-9418-4
  31. Kim S Il, Ha KY, Oh IS. Preemptive multimodal analgesia for postoperative pain management after lumbar fusion surgery: a randomized controlled trial. Eur Spine J. 2016;25(5):1614-1619. doi:10.1007/s00586-015-4216-3
  32. Kim DH, Park JY, Karm MH, et al. Smoking May Increase Postoperative Opioid Consumption in Patients Who Underwent Distal Gastrectomy with Gastroduodenostomy for Early Stomach Cancer. Clin J Pain. 2017;33(10):905-911. doi:10.1097/AJP.0000000000000472
  33. Kornilov N, Lindberg MF, Gay C, et al. Factors Related to Postoperative Pain Trajectories following Total Knee Arthroplasty: A Longitudinal Study of Patients Admitted to a Russian Orthopaedic Clinic. Pain Res Treat. 2016;2016. doi:10.1155/2016/3710312
  34. Liu SS, Buvanendran A, Rathmell JP, et al. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop. 2012;36(11):2261-2267. doi:10.1007/s00264-012-1623-5
  35. Savannah S, Bido J, Jamie C, Heidi Y, Jeffrey K, Elena L. Impact of preoperative opioid use on total knee arthroplasty outcomes. J Bone Jt Surg - Am Vol. 2017;99(10):803-808. doi:10.2106/JBJS.16.01200
  36. Tayrose G, Newman D, Slover J, Jaffe F, Hunter T, Bosco J. Rapid mobilization decreases length-of-stay in joint replacement patients. Bull Hosp Joint Dis. 2013;71(3):222-226.
  37. Larsen P, Elsoe R, Hansen SH, Graven-Nielsen T, Laessoe U, Rasmussen S. Incidence and epidemiology of tibial shaft fractures. Injury. 2015;46(4):746-750. doi:10.1016/j.injury.2014.12.027
  38. Chevalley T, Bonjour JP, Audet MC, et al. Fracture Prospectively Recorded From Prepuberty to Young Adulthood: Are They Markers of Peak Bone Mass and Strength in Males? J Bone Miner Res. 2017;32(9):1963-1969. doi:10.1002/jbmr.3174
  39. Farr JN, Melton LJ, Achenbach SJ, Atkinson EJ, Khosla S, Amin S. Fracture Incidence and Characteristics in Young Adults Aged 18 to 49 Years: A Population-Based Study. J Bone Miner Res. 2017;32(12):2347-2354. doi:10.1002/jbmr.3228
  40. Zolhavarieh SM, Mousavi‐Bahar SH, Mohseni M, Emam AH, Poorolajal J, Majzoubi F. Effect of intravenous acetaminophen versus fentanyl on postoperative pain after transurethral lithotripsy. Brazilian J Anesthesiol. 2019;69(2):131-136. doi:10.1016/j.bjan.2018.06.009
  41. Shrestha L, Joshi B, Palikhey A, Bhattarai K. Comparative Study on Efficacy of Ketorolac and Pethidine for Postoperative Pain Management. J Univers Coll Med Sci. 2019;7(1):27-32. doi:10.3126/jucms.v7i1.24682
  42. Routh JC, Graham DA, Nelson CP. Ketorolac is underutilized after ureteral reimplantation despite reduced hospital cost and reduced length of stay. Urology. 2010;76(1):9-13. doi:10.1016/j.urology.2009.10.062
  43. Pham TT, Bayle Iniguez X, Mansat P, Maubisson L, Bonnevialle N. Postoperative pain after arthroscopic versus open rotator cuff repair. A prospective study. Orthop Traumatol Surg Res. 2016;102(1):13-17. doi:10.1016/j.otsr.2015.11.005
  44. Desai VN, Cheung E V. Postoperative pain associated with orthopedic shoulder and elbow surgery: A prospective study. J Shoulder Elb Surg. 2012;21(4):441-450. doi:10.1016/j.jse.2011.09.021
  45. Cozowicz, C, Olson, A, Poeran, J, Mörwald, E, Zubizarreta, N, Girardi, F, Hughes, A, Mazumdar, M, Memtsoudis, S. PAIN. 2017;158(12):p 2422-2430. doi: 10.1097/j.pain.0000000000001047



DOI: https://doi.org/10.22146/jmpf.53313

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