DOI: https://doi.org/10.14710/jai.v6i3.9125

Kadar Serum Substansi P Pada Pemberian Klonidin Sebagai Ajuvan Analgesia Epidural

1RSUD Tarakan, Indonesia

2Kalimantan Utara, Indonesia

3Bagian Anestesi dan Terapi Intensif, Fakultas Kedokteran, Universitas Diponegoro/ RSUP Dr. Kariadi, Indonesia

4 Semarang, Indonesia

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Published: 1 Nov 2014.
Open Access Copyright 2014 JAI (Jurnal Anestesiologi Indonesia)

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Abstract

Latar belakang : Klonidin ketika digunakan bersamaan dengan obat lokal anestesi sebagai teknik regional anestesi, bisa mengurangi kejadian nyeri kronik pasca operasi. Sensitisasi perifer dan  sensitisasi sentral merupakan salah satu mekanisme terjadinya transisi nyeri akut menjadi nyeri kronik. Kaskade awal yang menyebabkan sensitisasi perifer dan sensitisasi sentral di picu oleh pelepasan neurotransmitter eksitatorik presinaptik dan pasca sinaptik seperti glutamat dan substansi P.

Tujuan : Membandingkan peningkatan  kadar serum substansi P pada 12 jam pasca operasi  dan nilai visual analog skor pada 0 dan 12 jam pasca operasi antara  analgesia epidural  dengan bupivakain murni dan bupivakain dengan ajuvan klonidin

Metode : penelitian ini merupakan penelitian acak tersamar ganda. Sampel 40 orang dibagi 2 kelompok, yaitu kelompok kontrol mendapat epidural analgesia dengan bupivacain murni dan kelompok kontrol mendapat epidural analgesia bupivakain ditambah ajuvan klonidin dimana pemberian analgesia dilakukan pra insisi dan dilanjutkan samapai pasca operasi. Kadar serum substansi P dinilai pra operasi dan 12 jam pasca operasi pada masing-masing kelompok perlakuan. Sedangkan nilai VAS diukur pada 0 dan 12 jam pasca operasi

Hasil : Terdapat perbedaan kadar serum substansi P berupa penurunan secara bermakna pada 12 jam pasca operasi baik pada kelompok kontrol dan perlakuan. Tidak terdapat perbedaan yang bermakna antara rerata kadar serum substansi P antara kelompok kontrol dan perlakuan pada 12 jam pasca operasi. Terdapat perbedan nilai VAS secara bermakna pada 0 dan 12 jam pasca operasi antara kelompok kontrol dan perlakuan

Simpulan : epidural analgesia dengan bupivacain maupun dengan ajuvan klonidin yang diberikan pra insisi yang dilanjutkan pasca operasi sama-sama efektif menurunkan kadar substansi P pada 12 jam pasca operasi.

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Keywords: analgesia epidural; klonidin; bupivakain; substansi P

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Language : ID
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  1. neurogenic iKehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006; 367: 1618–25
  2. Dworkin RH, McDermott MP, Raja SN. Preventing chronic postsurgical pain: how much of a difference makes a difference? Anesthesiology 2010; 112: 516–8
  3. Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother 2009; 9: 723–44
  4. Gartner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. daPrevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 2009; 302: 1985–92
  5. Katz J, Cohen L. Preventive analgesia is associated with reduced pain disability 3 weeks but not 6 months after major gynecologic surgery by laparotomy. Anesthesiology 2004; 101:169–74
  6. Bruce J, Poobalan AS, Smith WC, Chambers WA. Quantitative assessment of chronic postsurgical pain using the McGill Pain Questionnaire. Clin J Pain 2004; 20:70–5
  7. Kalso E, Mennander S, Tasmuth T, Nilsson E. Chronic poststernotomy pain. Acta Anaesthesiol Scand 2001; 45: 935–9
  8. Bay-Nielsen M, Perkins FM, Kehlet H. Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 2001; 233:1–7
  9. Haythornthwaite JA, Raja SN, Fisher B, Frank SM, Brendler CB,Shir Y. Pain and quality of life following radical retropubic prostatectomy. J Urol 1998; 160: 1761–4
  10. Gottschalk A, Smith DS, Jobes DR, et al. Preemptive epidural analgesia and recovery from radical prostatectomy: a randomized controlled trial. JAMA 1998; 279: 1076–82
  11. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 2000; 93: 1123–33
  12. Pluijms WA, Steegers MA, Verhagen AF, Scheffer GJ, Wilder-Smith OH. Chronic post-thoracotomy pain: a retrospec-tive study. Acta Anaesthesiol Scand 2006; 50: 804–8
  13. Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain 1996; 12:50–5
  14. Hagains CE, Trevino LA, He JW, Liu H, Peng YB. Contributions of dorsal root reflex and axonal reflex to formalin-induced inflammation. Brain Res 2010; 1359:90–7
  15. Foreman JC. Peptides and nflammation. Br Med Bull 1987; 43: 386
  16. Hinsey JC, Gasser HS. The component of the dorsal root mediating vasodilation and the Sherrington contracture. Am J Physiol 1930; 92: 679
  17. Chahl LA. Antidromic vasodilation and neurogenic inflammation. Pharmacol Ther 1988; 37: 275-300
  18. Cavagnaro J, Lewis RM. Bidirectional regulatory circuit between the immune and neuroendocrine systems. Year Immunol 1989; 4: 241-252
  19. Lambiase A, Bonini S, Micera A, Tirassa P, Magrini L, Bonini S, Aloe L. Increased plasma levels of substance P in vernal keratoconjunctivitis. Investigative opthalmology & visual science 1997;10(38):2161-64
  20. Searle RD, Simpson KH.Cronic post-surgical pain. Cont Edu Anaesth Crit Care & Pain. 2010;10(1):12-14
  21. Coderre TJ, Melzack R. Central neural mediators of secondary hyperalgesia following heat injury in rats: neuropeptides and excitatory amino acids. Nerurosci Lett 1991;131:71-4
  22. Ferreira SH, Lorenzetti BB. Glutamate spinal retrograde sensitization of primary sensory neurons associated with nociception. Neuropharmacology 1994;33:1479-85
  23. Papp A, Valtonen P. Tissue substance P level in acute experimental burns.Burns 2006;32:842-45
  24. Kamisaki Y, Hamada T, Maeda K, Ishimura M, Itoh T. Presynaptic alpha-2 adrenoceptors inhibit glutamate release from rat spinal cord synaptosome. J Neurochem 1993;60:522-6
  25. Gong H, Liu Q, Yang X, Liu Z, Liu G, Li Z. Effects of selective alpha 2-adrenoreseptor stimulation on capsaicin-evoked substance P release from primary cultured dorsal root ganglion neurons. Pharmazie 2010; 65: 202-5
  26. Gertler, R., Brown, H.C., Mitchell, D.H. and Silvius, E.N. (2001) Dexmedetomidine: a novel sedative-analgesic agent. Baylor University Medical Center Proceedings 14, 13-21
  27. Bost KL, Breeding SA, Pascual DW. Modulation of the mRNAs encoding substance P and its receptor in rat macrophages by LPS. Reg Immunol 1992; 4(2):105–112
  28. Killingsworth CR, Shore SA, Alessandrini F, Dey RD, Paulauskis JD. Rat alveolar macrophages express preprotachykinin gene-I mRNA-encoding tachykinins. Am J Physiol 1997; 273(5 Pt 1):L1073–L1081
  29. Joos GF, Germonpre PR, Pauwels RA. Role of tachykinins in asthma. Allergy 2000; 55(4):321–337
  30. Holzer P, Holzer-Petsche U. Tachykinins in the gut. Part II. Roles in neural excitation, secretion, and inflammation. Pharmacol Ther 1997;73(3):219–263
  31. O’connor TM, O’Connell J, O’Brien DI, Goode T, Bredin CP, Shanahan F. The Role of substance P in inflammatory disease. Journal of cellular physiology. 2004;201: 167-180
  32. Trivedi M, Bergata N.V. Serum concentration of substance P in cholelitiasis. Annals of hepatology. 2010; 9(2):177-180
  33. Lambiase A, Bonini S, Micera A, Tirassa P, Magrini L, Aloe L, et al. Increase plasma level of substance P in vernal keratoconjungtivitis.investigative opthalmology and visual science. 1999;32(10):2161-64
  34. Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science 2000;288(5472):1765-9
  35. Wu CT, Yeh CC, Yu JC, Lee MM, Tao PL, Ho ST, et al. Pre-incisional epidural ketamine, morphine and bupivacaine combined with epidural and general anaesthesia provides pre-emptive analgesia for upper abdominal surgery. Acta Anaesthesia Scand 2000; 44:63-8
  36. Senturk M, Ozcan PE, Talu GK et al. The effects of three different analgesia techniques on long-term postthoracotomy pain. Anesth Analg 2002;94(1):11-5
  37. Lavand’homme P, De Kock M, Waterloos H. Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery. Anesthesiology 2005;103(4):813-20
  38. Kairaluoma PM, Bachmann MS, Rosenberg PH et al. Preincisional paravertebral block reduces the prevalence of chronic pain after breast surgery. Anest Analg 2006;103(3):703-8
  39. Dahl JB, Moiniche S. Pre-emptive analgesia. Br Med Bull 2004;71:13-27
  40. Jyothi, H. Verma, S. Safiya: A Prospective Randomised Study Of Combination Of Epidural Bupivacaine With Clonidine And Bupivacaine For Postoperative Analgesia. The Internet Journal of Anesthesiology 2012; 30(2). DOI: 10.5580/2b74

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