DOI: https://doi.org/10.14710/jai.v14i1.45221

Perbandingan Pengaruh Pemberian Ketamin 0,1 mg/KgBB dan Parasetamol 1000 mg Secara Intravena Terhadap Kadar Interleukin-6 pada Pasien Pasca Lower Limb Orthopedic Surgery

Departemen Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Diponegoro, Semarang, Indonesia

Received: 15 Mar 2022; Revised: 25 Mar 2022; Accepted: 20 Apr 2022; Available online: 16 Sep 2022; Published: 16 Sep 2022.
Open Access Copyright 2022 JAI (Jurnal Anestesiologi Indonesia)

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Abstract

Latar Belakang: Lower limb orthopedic surgery merupakan tindakan bedah ortopedik pada ekstremitas inferior yang meliputi tulang, sendi, dan vaskular. Peningkatan interleukin-6 (IL-6) sistemik setelah pembedahan meningkatkan morbiditas dan mortalitas pascaoperasi. Sebagai analgesik, ketamin dan parasetamol mempengaruhi ekspresi IL-6.

Tujuan: Penelitian ini adalah untuk membandingkan pengaruh pemberian ketamin 0,1mg/Kg IV dengan parasetamol 1000 mg IV terhadap kadar IL-6 pada pasien pasca lower limb orthopedic surgery yang mendapatkan regional anestesi.

Metode: Penelitian ini menggunakan randomized control trial pada 54 pasien yang telah menjalani lower limb orthopaedic surgery dan memenuhi kriteria inklusi dan eksklusi. Sampel dibagi menjadi 3 kelompok yang terdiri dari kontrol (K); epidural bupivakain 0,125%, perlakuan 1 (P1); dengan tambahan ketamin 0,1 mg/KgBB IV dan perlakuan 2 (P2); dengan tambahan parasetamol 1000 mg IV pascaoperasi. Sampel darah diambil 2 jam pascaoperasi untuk diukur kadar IL-6 menggunakan metode enzyme linked immunosorbent assay (ELISA).

Hasil: Penelitian ini menghasilan nilai rerata IL-6 kelompok K = 72,22±66,93 pg/ml; P1 = 7,18±4,18 pg/ml dan P2 = 7,00±2,92 pg/ml. Uji Kruskal Wallis menunjukkan nilai signifikan (p=0,000). Hasil penelitian menunjukkan nilai signifikan pada K terhadap P1 (p=0,000) dan K terhadap P2 (p=0,000), sedangkan P1 terhadap P2 tidak signifikan (p=0,438).

Kesimpulan: Pemberian ketamin atau parasetamol pasca lower limb orthopaedic surgery secara signifikan menurunkan kadar IL-6. Tidak ada perbedaan antara ketamin dan parasetamol dalam menurunkan kadar IL-6 pascaoperasi lower limb orthopedic surgery. 

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Keywords: interleukin-6; ketamine; lower limb orthopaedic surgery; parasetamol; regional anestesi

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  1. Busato A, Widmer M, Matter P. Variation in incidence of orthopaedic surgery between populations with basic or basic plus supplementary health insurance in Switzerland. Swiss Med Wkly. 2011;141(FEBRUARY):1–7
  2. Bauer, M., George, J. E., Seif, J., & Farag E. Recent advances in epidural analgesia. Anesthesiol Res Pract. 2012;
  3. Jawa RS, Anillo S, Huntoon K, Baumann H, Kulaylat M. Analytic review: Interleukin-6 in surgery, trauma, and critical care: part I: basic science. J Intensive Care Med. 2011;26(1):3–12
  4. Jawa RS, Anillo S, Huntoon K, Baumann H, Kulaylat M. Interleukin-6 in surgery, trauma, and critical care part II: clinical implications. J Intensive Care Med. 2011;26(2):73–87
  5. Chen RM, Chen TG, Lin LL, Chang CC, Wu CH. Anti-inflamatory and antioxidative effects of propofol on lipopolysaccharide- activated macrophages. Ann NY Acad Sci. 2005;1042:262–71
  6. Chen RM, Chen TL, Lin YL, Chen TG TY. Ketamin reduces nitirc oxide biosynthesis in human umbilical vein endhotelial cells by down-regulating endhitelial nitric oxide synthase expression and intracellular calcium levels. Crit Care Med. 2005;33:1044–9
  7. Luggya TS, Roche T, Ssemogerere L, Kintu A, Kasumba JM, Kwizera A, et al. Effect of low-dose ketamine on post-operative serum IL-6 production among elective surgical patients: a randomized clinical trial. Afr Health Sci. 2017 Jun;17(2):500–7
  8. Wrotek S, Sobocińska J, Kozłowski HM, Pawlikowska M, Jędrzejewski T, Dzialuk A. New insights into the role of glutathione in the mechanism of fever. Int J Mol Sci. 2020;21(4)
  9. Beilin B, Rusabrov Y, Shapira Y, Roytblat L, Greemberg L, Yardeni IZ, et al. Low-dose ketamine affects immune responses in humans during the early postoperative period. Br J Anaesth. 2007;99(4):522–7
  10. Supomo S. Correlation of Interleukin-6 serum level and surgical site infection in post major surgery patient. Bali Med J. 2018;8(1):18
  11. Gump B, McMullan D, Cauthon D, Moore MS, Whitt JA, Tedeschi J, et al. The effect of acetaminophen on post-exercise IL-6 levels in human Achilles peritendinous tissue. FASEB J. 2011 Apr 1;25(S1):1107.1-1107.1
  12. Sanz-Garcia C, Ferrer-Mayorga G, González-Rodríguez Á, Valverde ÁM, Martín-Duce A, Velasco-Martín JP, et al. Sterile inflammation in acetaminophen-induced liver injury is mediated by Cot/tpl2. J Biol Chem. 2013;288(21):15342–51
  13. Akira S, Takeda K. Toll-like receptor signalling. Nat Rev Immunol. 2014;4(7):499–511
  14. O’Neill LAJ, Bowie AG. The family of five: TIR-domain-containing adaptors in Toll-like receptor signalling. Nat Rev Immunol. 2007;7(5):353– 64
  15. Gantke T, Sriskantharajah S, Sadowski M, Ley SC. IκB kinase regulation of the TPL-2/ERK MAPK pathway. Immunol Rev. 2012 Mar;246(1):168–82
  16. Vougioukalaki M, Kanellis DC, Gkouskou K, Eliopoulos AG. Tpl2 kinase signal transduction in inflammation and cancer. Cancer Lett. 2011;304(2):80–9
  17. Caivano M, Rodriguez C, Cohen P, Alemany S. 15-Deoxy-Delta12,14- prostaglandin J2 regulates endogenous Cot MAPK kinase kinase 1 activity induced by lipopolysaccharide. J Biol Chem. 2013 Dec;278(52):52124–30
  18. Dumitru CD, Ceci JD, Tsatsanis C, Kontoyiannis D, Stamatakis K, Lin JH, et al. TNF-alpha induction by LPS is regulated posttranscriptionally via a Tpl2/ERK-dependent pathway. Cell. 2010 Dec;103(7):1071–83
  19. López-Peláez M, Soria-Castro I, Boscá L, Fernández M, Alemany S. Cot/tpl2 activity is required for TLR-induced activation of the Akt p70 S6k pathway in macrophages: Implications for NO synthase 2 expression. Eur J Immunol. 2011 Jun;41(6):1733–41
  20. Gándara ML, López P, Hernando R, Castaño JG, Alemany S. The COOH- terminal domain of wild-type Cot regulates its stability and kinase specific activity. Mol Cell Biol. 2003 Oct;23(20):7377–90
  21. Waterfield MR, Zhang M, Norman LP, Sun SC. NF-kappaB1/p105 regulates lipopolysaccharide-stimulated MAP kinase signaling by governing the stability and function of the Tpl2 kinase. Mol Cell. 2003 Mar;11(3):685–94
  22. Das S, Cho J, Lambertz I, Kelliher MA, Eliopoulos AG, Du K, et al. Tpl2/cot signals activate ERK, JNK, and NF-kappaB in a cell-type and stimulus- specific manner. J Biol Chem. 2005 Jun;280(25):23748–57
  23. Perugorria MJ, Murphy LB, Fullard N, Chakraborty JB, Vyrla D, Wilson CL, et al. Tumor progression locus 2/Cot is required for activation of extracellular regulated kinase in liver injury and toll-like receptor-induced TIMP-1 gene transcription in hepatic stellate cells in mice. Hepatology. 2013 Mar;57(3):1238–49
  24. Gaestel M, Kotlyarov A, Kracht M. Targeting innate immunity protein kinase signalling in inflammation. Nat Rev Drug Discov. 2009;8(6):480–99
  25. Cohen P. Targeting protein kinases for the development of anti- inflammatory drugs. Curr Opin Cell Biol. 2009 Apr;21(2):317–24
  26. Soria-Castro I, Krzyzanowska A, Pelaéz ML, Regadera J, Ferrer G, Montoliu L, et al. Cot/tpl2 (MAP3K8) mediates myeloperoxidase activity and hypernociception following peripheral inflammation. J Biol Chem. 2010/08/24. 2010 Oct 29;285(44):33805–15
  27. Kula A, Akkar OB, Gulturk S, Cetin M, Cetin A. Combination of paracetamol or ketamine with meperidine enhances antinociception. Hum Exp Toxicol. 2016 Aug;35(8):887–92
  28. Rahimzadeh P, Imani F, Alimian M, Behzadi B, Faiz S-H-R. Comparison between ketamine and acetaminophen administered at the end of anesthesia for pain management after hysterectomy TT
  29. Asadi HK, Nikooseresht M, Noori L, Behnoud F. The effect of administration of ketamine and paracetamol versus paracetamol singly on postoperative pain, nausea and vomiting after pediatric adenotonsillectomy. Anesthesiol Pain Med. 2016;6(1):14–6
  30. Heydari S, Hashemi S, Pourali S. The Comparison of Preventive Analgesic Effects of Ketamine, Paracetamol and Magnesium Sulfate on Postoperative Pain Control in Patients Undergoing Lower Limb Surgery: A Randomized Clinical Trial. Adv Biomed Res. 2017;6(1):134
  31. Yalcin N, Uzun ST, Reisli R, Borazan H, Otelcioglu S. A Comparison of Ketamine and Paracetamol for Preventing Remifentanil Induced Hyperalgesia in Patients Undergoing Total Abdominal Hysterectomy. Int J Med Sci. 2012;9(5):327–33
  32. Khajavi MR, Sabouri SM, Moharari RS, Pourfakhr P, Najafi A, Etezadi F, et al. Multimodal analgesia with ketamine or tramadol in combination with intravenous paracetamol after renal surgery. Nephrourol Mon. 2016;8(4)
  33. Jeremić V, Alempijević T, Mijatović S, Sijački A, Dragašević S, Pavlović S, et al. Clinical relevance of IL-6 gene polymorphism in severely injured patients. Bosn J basic Med Sci. 2014 May;14(2):110–7

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