DOI: https://doi.org/10.14710/jai.v7i2.9820

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

1Departemen Anestesiologi dan terapi Intensif, Fakultas Kedokteran, Unversitas Diponegoro/ RSUP Dr. Kariadi, Indonesia

2Semarang, Indonesia

Published: 1 Jul 2015.

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Abstract

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.

 

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Keywords: Paracetamol intravena; Substansi P; VAS; Morfin; Kraniotomi

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