Kadar Substansi P Serum Pada Pemberian Parasetamol Intravena Perioperatif Pada Pasien Kraniotomi
ABSTRACT

Background: Pain management after craniotomy is very important, 60-84% patient experience moderate to severe pain. Postoperative pain especially transmitted by C fiber neurons involved neuropeptide Substance P (SP). Postoperative opioid analgesia gives some adverse effect, such as allergy, gastrointestinal effect, nausea. vomiting, hypotension, sedation, repiratory depression and urinary retention. Paracetamol has opioid sparing effect that may reduce the need of opioid analgesia, and also inhibits SP mediated hyperalgesia.

Objective: To study the effect of perioperative intravenous paracetamol on SP level in post craniotomy patient

Methods: Forty subject aged 18 – 45 years underwent elective craniotomy intracerebral tumour resection who have ASA physical status I-II,  divided into 2 groups. P group received 1000 mg intravenous paracetamol every 6 hours during 24 hours postoperative, K group received placebo. Postoperative analgesia using morphine syringe pump 0,01 mg/Kg/hour titration to VAS. SP serum levels were examined with Cusabio substance Elisa kit ELx 800 before and 12 hours after surgery. Visual Analog Scale noted in 1, 6, 12, and 24 hours postoperative. Total amount of morphine given, nausea and vomiting was noted.

Results: Preoperative SP level in P group was 16,89± 31,395 pg/ml and 36,58 ± 46,960 pg/ml postoperatively. Preoperative SP Level in K group was 9,58 ± 10,656 pg/ml and 26,09 ± 22,506 pg/ml postoperatively. SP level elevation in P group and K group were 19,69± 28,625 pg/ml and 16,51 ± 14,972 pg/ml. Postoperative SP level and the elevation were not significantly different between two groups (p=0,793 and p=0,540),  VAS and total amount of morphine given was significantly different (p<0,05).

Conclusion: Perioperative intravenous paracetamol reduced morphine consumption and gave better VAS in post craniotomy patient, but did not affected postoperative SP level.

 

Keywords : Intravenous paracetamol, Substance P, VAS, Morphine, Craniotomy
ABSTRAK

Latar belakang: Manajemen nyeri pasca kraniotomi sangat penting karena 60-84% pasien pasca kraniotomi merasakan nyeri sedang hingga berat. Rasa nyeri ini ditransmisikan olehserabutsaraf C yang melibatkan neuropeptida substansi P (SP). Pemberian analgetik golongan opioid memiliki efek samping seperti alergi, gangguan gastrointestinal, mual, muntah, hipotensi, depresi nafas maupun retensi urin. Paracetamol memiliki efek yang mengurangi kebutuhan analgesia opioid, dan menghambat hiperalgesia yang dimediasi oleh SP.

Tujuan: Mengetahui efek pemberian parasetamol intravena perioperatif terhadap kadar SP serum pasca kraniotomi.

Metode: Empat puluh responden berusia 18-45 tahun akan menjalani kraniotomi reseksi tumor intraserebral elektif, ASA I-II, dibagi menjadi 2 kelompok. Kelompok P diberikan paracetamol 1000 mg intravena per 6 jam selama 24 jam pasca operasi, kelompok K mendapat plasebo. Analgetik pasca operasi menggunakan morfin syringe pump 0,01 mg/kg/jam titrasi sesuai VAS.  Level SP serum diperiksa menggunakan Cusabio SP ELISA kit sebelum operasi dan 12 jam setelah operasi. VAS dinilai pada jam 1, 6, 12, dan 24 jam pasca operasi. Jumlah total pemakaian morfin dalam 24 jam dan efek mual muntah dicatat.

Hasil: Kadar SP pra operasi pada kelompok P 16,89± 31,395 pg/ml dan pasca operasi 36,58 ± 46,960 pg/ml. Level SP pra operasi kelompok K 9,58 ± 10,656 pg/ml dan pasca operasi 26,09 ± 22,506 pg/ml. Peningkatan kadar SP pasca operasi kelompok P sebesar 19,69± 28,625 pg/ml, sedangkan kelompok K 16,51 ± 14,972 pg/ml. Tidak terdapat perbedaan bermakna antara kadar SP dan  peningkatannya pada kedua kelompok penelitian (p=0,793 dan p=0,540), sedangkan nilai  VAS dan jumlah morfin yang diberikan berbeda bermakna (p<0,05).

Simpulan: Pemberian parasetamol intravena perioperatif pada pasien kraniotomi mengurangi kebutuhan morfin dan nilai VAS lebih baik, namun tidak mempengaruhi kadar SP pasca operasi.

 

Kata kunci : Paracetamol intravena, Substansi P, VAS, Morfin, Kraniotomi
Artikel Sekarang
Dipublikasi pada 01 July 2015
Penulis :
» Bondan Irtani Cahyadi
» Hariyo Satoto
» Heru Dwi Jatmiko
Kategori : Penelitian
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Volume VII Nomor 2, Juli 2015 Cover JAI
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