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"[Latar Belakang : Sesak napas merupakan keluhan utama pada kanker paru. Obatgolongan opioid seperti morfin dapat digunakan untuk mengurangi keluhan sesaknapas. Penelitian ini bertujuan untuk menetapkan efek pengurangan sesak napasdengan pemberian morfin oral lepas lambat 2x10 mg dan 2x30 mg, serta efeksamping yang ditimbulkan. Metode : Penelitian uji klinis dengan subjek pasien kanker paru denganmembandingkan keluhan sesak napas sebelum dan sesudah pemberian morfin oral2x10 mg selama 2 hari dan dilanjutkan dengan 2x30 mg selama 2 hari. Derajatsesak dinilai dengan menggunakan skor sesak modified Borg?s dyspnea scale danVisual Analog Scale (VAS) untuk sesak. Efek samping dipantau selamapemberian obat. Hasil : Tiga puluh tiga peserta penelitian dengan 27 laki-laki (81,8%), jeniskanker paru adenokarsinoma 25 orang (75,8%). Terdapat perbaikan keluhan sesaknapas setelah morfin 2x10 mg pada 18 dari 33 peserta (54,5%) dengan penurunanrata-rata skor sesak Borg dan VAS sebanyak 0,70 dan 6,72 dengan p <0,001dibanding skor awal. Setelah pemberian morfin 2x30 mg perbaikan sesak napasdidapat pada 26 dari 33 peserta (78,8%) dengan penurunan rata-rata skor sesakBorg dan VAS sebanyak 1,64 dan 16,06 dengan p <0,001 dibanding skor awal.Terdapat perbedaan bermakna antara pemberian morfin 2x10 mg dan 2x30 mg (p<0,001). Efek samping yang didapat setelah morfin 2x30 mg yaitu 33,3%mengeluh konstipasi, 42,4% mengantuk, dan 12,1% mual. Tidak ada pasien yangmengalami depresi pernapasan berat. Kesimpulan : Terdapat perbaikan keluhan sesak napas setelah pemberian morfinoral lepas lambat 2x10 mg dan dan perbaikan yang lebih baik dengan 2x30 mg. Tidak ada efek samping yang berat setelah pemberian morfin oral.;Background: Dyspnea is a major complaint in lung cancer. Opioids drugs such as morphine is known to be used to reduce dyspnea. This study aims to determinewhether there is an improvement of dyspnea by titrating morphine sustainedrelease tablet 2x10 mg and 2x30 mg in lung cancer patient, and the side effectsthat appear. Methods: The study is a clinical trial with the subject of lung cancer patients bycomparing dyspnea before and after administration of 2x10 mg morphine tabletsfor 2 days, followed by 2x30 mg for 2 days. The degree of dyspnea assessed usingthe modified Borg's dyspnea scale and the Visual Analog Scale (VAS) fordyspnea. Side effects are observed during administration of the drug. Results: Thirty-three study participants with predominantly 27 men (81.8%) and25 participants with adenocarcinoma (75.8%). There were improvements indyspnea after morphine 2x10 mg in 18 of the 33 participants (54.5%) with anaverage improvements of Borg and VAS scores for 0.70 and 6.72 with p <0.001compared to the initial score. After administration of morphine 2x30 mgimprovements in dyspnea were obtained in 26 of the 33 participants (78.8%) withan average improvements of Borg and VAS scores for 1.64 and 16.06 with p<0.001 compared to the initial score. There were significant differences betweenthe administration of morphine 2x10 mg and 2x30 mg (p <0.001). Side effectswere obtained after 2x30 mg morphine such as 33.3% complained of constipation,drowsiness in 42.4%, and nausea in 12.1%. No patients experienced severerespiratory depression. Conclusion: There is dyspnea improvement after administration of sustainedreleasemorphine tablet 2x10 mg and better improvement with 2x30 mg. No severe side effects after administration of oral morphine., Background: Dyspnea is a major complaint in lung cancer. Opioids drugs such as morphine is known to be used to reduce dyspnea. This study aims to determinewhether there is an improvement of dyspnea by titrating morphine sustainedrelease tablet 2x10 mg and 2x30 mg in lung cancer patient, and the side effectsthat appear. Methods: The study is a clinical trial with the subject of lung cancer patients bycomparing dyspnea before and after administration of 2x10 mg morphine tabletsfor 2 days, followed by 2x30 mg for 2 days. The degree of dyspnea assessed usingthe modified Borg's dyspnea scale and the Visual Analog Scale (VAS) fordyspnea. Side effects are observed during administration of the drug. Results: Thirty-three study participants with predominantly 27 men (81.8%) and25 participants with adenocarcinoma (75.8%). There were improvements indyspnea after morphine 2x10 mg in 18 of the 33 participants (54.5%) with anaverage improvements of Borg and VAS scores for 0.70 and 6.72 with p <0.001compared to the initial score. After administration of morphine 2x30 mgimprovements in dyspnea were obtained in 26 of the 33 participants (78.8%) withan average improvements of Borg and VAS scores for 1.64 and 16.06 with p<0.001 compared to the initial score. There were significant differences betweenthe administration of morphine 2x10 mg and 2x30 mg (p <0.001). Side effectswere obtained after 2x30 mg morphine such as 33.3% complained of constipation,drowsiness in 42.4%, and nausea in 12.1%. No patients experienced severerespiratory depression. Conclusion: There is dyspnea improvement after administration of sustainedreleasemorphine tablet 2x10 mg and better improvement with 2x30 mg. No severe side effects after administration of oral morphine.]"

"Studi ini bertujuan untuk mengetahui keefeletifan parecoxib 40 mg intravena dibandingkan dengan morfin 5 mg intravena sebagai analgesik pada 24 jam pertama pascalaparotomi ginekologi. Enampuluh empat pasien laparotomi ginekologi mendapatkan intervensi parecoxib 40 mg iv atau morfin 5 mg iv pascabedah. Nilai VAS, waktu untuk kebutuhan petidin pertama, jumlah kebutuhan petidin dan efek samping opioid dicatat sampai 24 jam setelah intervensi.Didapatkan nilai rerata penurunan intensitas nyeri (PID) antara kedua kelompok tidak berbeda bermakna (p>0,05), dengan rerata PID 0-6 jam sebesar 33,3 (SE 3,3) untuk? kelompok parecoxib dan 38,4 (SE 4,2) untuk kelompok morfin. Rerata waktu pemberian petidin pertama tidak berbeda bermakna yaitu 2 jam 53 menit (parecoxib) dan 1 jam 44 menit (morfin); p>0,05). Rerata kebutuhan petidin 24 jam juga tidak berbeda bermakna yaitu 51,6 mg (SE 5,8) dan 55,5 mg (SE 4,6); p>0,05. Efek samping opioid berupa sedasi lebih banyak pada kelompok morfin yaitu 21 pasien (65,6%) vs 12 (37,5%); p=0,024. Efek samping opioid berupa mual, muntah dan pusing tidak berbeda bermakna.Disimpulkan bahwa parecoxib 40 mg iv tidak lebih baik(daripada morfin 5 mg iv dalam memberikan efek analgesia untuk nyeri pasacalaparotorni ginekologi.

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Objective: The purpose of this study was to compare the analgesic activity of parecoxib 40 mg iv and morphine 5 mg iv in 24 hours after gynecologic surgery that requires laparotomy.

Study design: In a randomized, controlled, double-blind, 64 patiets after gynecoloogic laparotomy surgery received single-dose intravenous parecoxib 40 mg or morphine .5 mg followed by repeated 25 mg iv pethidine as analgesic rescue drugs.Primary efficacy variables were pain intensity difference (PID), time to first recue/remedication, total pethidin dose over 24 hours, and opioid-sparring side effects were recorded.

Results: Parecoxib 40 mg iv did not provide better pain responses than morphine 5 mg iv. Zero to 6 hours PID between parecoxib group and morphine grows were 33.3 (SE 3,3) versus 38,4 (SE 4,2; p>0,05). Mean time to first recuelremedication were 2h53min (parecoxib group) versus lh44min (morphine graup); p>0,05. Mean total pethidine dose in 24 hours were 51.6 mg (SE 5,8) versus 55,5 mg (SE 4,6) for parecoxib group and morphine group respectively; p>0,05. Morphine group showed more sedation parecoxib group; 21 pis (65,6%) versus 12 (37.5%); p-0,024. Other opioid-sparring side effects were comparable between both groups.

Conclusion: Parecoxib 40 mg iv did not provide better analgesic activity than morphine 5 mg iv in 24 hours after gynecologic surgery that requires laparotomy."

"Latar belakang: Nyeri pascabedah ortopedi ekstremitas bawah masih menjadi masalah yang berkaitan dengan risiko pascabedah dan lama perawatan di rumah sakit. PCA intravena morfin dan oxycodone masih belum dikaji lebih jauh sebagai analgesia pascabedah ortopedi ekstremitas bawah.Metode: Penelitian ini merupakan uji klinik acak tersamar ganda untuk menilai efektivitas PCA intravena morfin dengan oxycodone untuk analgesia pascabedah ortopedi ekstremitas bawah. Subjek penelitian berjumlah 50 orang yang didapatkan dengan consecutive sampling selama Januari-April 2019. Pasien dibagi menjadi 2 kelompok, dirandomisasi menjadi kelompok morfin dan kelompok oxycodone. Efektivitas dinilai dengan banyaknya konsumsi opioid dalam 24 jam pascabedah dan efek samping antara 2 kelompok. Penilaian derajat nyeri diam dan bergerak pada jam ke-0, 6, 12, dan 24 dengan menggunakan Visual Analogue Score (VAS) dan kepuasan pasien pada penggunaan PCA juga dinilai untuk komponen penilaian tambahan. Hasil dianalisis dengan SPSS.Hasil: Seluruh subjek penelitian menyelesaikan penelitian dan tidak didapatkan perbedaan karakteristik yang signifikan antara 2 kelompok. Banyaknya konsumsi opioid dalam 24 jam pertama pascabedah antara 2 kelompok (p 0,574) dan kejadian efek samping antara 2 kelompok tidak berbeda. Derajat nyeri istirahat dan bergerak juga tidak didapatkan hasil yang berbeda bermakna (p 0,109 ; 0,163). Kepuasan pasien pada penggunaan PCA juga tidak berbeda bermakna, namun secara umum pasien puas dengan penggunaan PCA, dan kepuasan pasien pada PCA oxycodone (76%) lebih banyak dibanding PCA morfin (52%)Simpulan: PCA intravena oxycodone tidak lebih efektif dibandingkan PCA intravena morfin untuk analgesia pascabedah ortopedi ekstremitas bawah pada penelitian ini. Pasien yang setuju dengan penggunaan PCA sebanyak 30 subjek, tidak ada perbedaan signifikan antara 2 kelompok.

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Background: Postoperative pain after lower extremity orthopedic surgery may increase morbidity after surgery and prolong the length of hospitalization. The study investigating effectiveness intravenous PCA morphine and oxycodone has not been extensively studied for managing pain after lower extremity orthopedic surgery.

Methods: This study is a double-blind randomized study clinical trial to evaluate effectiveness intravenous PCA morphine and oxycodone for post-operative analgesia after lower extremity orthopedic surgery. Total of 50 subjects were enrolled with consecutive sampling within January-April 2019. Subjects were randomly allocated into 2 groups, received intravenous PCA morphine or intravenous PCA oxycodone. Post-operative opioid consumption in 24 hours and side effects were considered the primary efficacy variable. Pain scores were measured using Visual Analogue Score (VAS) at time 0, 6, 12, and 24 after surgery. Patient satisfaction in both groups was also evaluated. Data was analyzed statistically using SPSS.

Results: All the subjects done this study. There were no differences in the characteristics of both groups. Opioid consumption between two groups no significantly different (p 0,574) and incidence of side effects between two groups were similar. Pain scores during rest and move also no significant differences (p 0,109 ; 0,163). Patient satisfaction no significant difference, but almost patient satisfied with using PCA, while group oxycodone (76%) higher than group morphine (52%).

Conclusion: Intravenous PCA oxycodone had no more effective than intravenous PCA morphine for post-operative analgesia after lower extremity orthopedic surgery in this study. Patient satisfaction was higher in group oxycodone than in group morphine."

"Latar Belakang. Nyeri pascaoperasi abdomen bawah merupakan salah satu komplikasi yang sering dikeluhkan pasien. Walaupun intensitasnya lebih rendah dibandingkan nyeri pascaoperasi abdomen atas, tetapi prosedur pembedahan ini lebih sering dilakukan di rumah sakit. Penggunaan gabapentin sebagai analgesia preemtif yang diberikan dua jam sebelum operasi dilaporkan dapat mengurangi nyeri pascaoperasi dan mengurangi kebutuhan analgesia pascaoperatif pada pasien yang menjalani pembedahan. Penelitian mengenai efektivitas gabapentin oral sebagai analgesia preemtif pada operasi abdomen bawah belum pernah dilakukan di Indonesia. Metode. Uji klinis acak tersamar ganda terhadap 72 subjek yang didapatkan dengan consecutive sampling pada November 2019 – Februari 2020 di RSU Kabupaten Tangerang. Subjek yang memenuhi kriteria dirandomisasi menjadi dua kelompok untuk mendapatkan regimen analgesia preemtif gabapentin 600 mg oral atau plasebo dua jam sebelum insisi. Pasien dilakukan penilaian kebutuhan morfin, derajat nyeri, saat pertama membutuhkan morfin, dan efek samping pada kedua kelompok dalam 24 jam pertama pascaoperasi. Analisis hasil menggunakan uji general linear model (GLM) dan anova untuk pengukuran berulang dan Mann-Whitney U. Hasil. Uji GLM menunjukkan ada perbedaan bermakna pada total kebutuhan morfin dalam 24 jam pascaoperasi antara kelompok gabapentin (2,47±1,90 mg) dengan plasebo (5,33±1,97 mg; p<0,001). Derajat nyeri saat istirahat dan bergerak saat pulih sadar, 2 jam, 6 jam, 12 jam, dan 24 jam pascaoperasi antara kedua kelompok didapatkan hasil berbeda bermakna dengan p<0,05. Uji Mann-Whitney menunjukkan ada perbedaan bermakna pada saat pertama subjek membutuhkan morfin untuk rescue analgesia antara kelompok gabapentin (161,5 [25 – 990] menit) dengan plasebo (67,5 [10 – 371] menit) dengan p<0,001. Kejadian mual pada kelompok gabapentin didapatkan lebih rendah dibandingkan kelompok plasebo. Simpulan. Gabapentin 600 mg oral lebih efektif dibandingkan plasebo sebagai analgesia preemtif pada operasi abdomen bawah nonobstetrik. Kejadian mual lebih sedikit pada pemberian analgesia preemtif gabapentin.

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Background. Lower abdominal postoperative pain is one of the most common postoperative complications reported by the patients. Although the pain intensity is lower than upper abdominal postoperative pain, lower abdominal surgery procedures are more often conducted in the hospital. Gabapentin therapy as preemptive analgesia given two hours before surgery has been reported to reduce postoperative pain and decrease postoperative analgesia requirements. There have been no studies in Indonesia reporting the effectiveness of oral gabapentin as preemptive analgesia to reduce lower abdominal postoperative morphine requirements. Method. Double-blind randomized clinical trial was conducted from 72 subjects by consecutive sampling on 2019 November-2020 February at Tangerang District General Hospital. Subjects fulfilling criteria were randomized into two groups and were given gabapentin 600 mg orally or placebo two hours before incision. Patients’ morphine requirements, pain scale at the first time morphine administration, and side effects on two groups on the first 24 hour postoperative were assessed. Result analysis was conducted using general linear model (GLM) and anova for repeated measurements and Mann-Whitney U. Result. GLM showed that there was significant difference on first 24-hour postoperative total morphine requirements between gabapentin group (2.47±1.90 mg) and placebo group (5.33±1.97 mg; p<0.001). Pain scale at rest and movement while on recovery, 2 hours, 6 hours, 12 hours, and 24 hours after surgery were significantly different between two groups with p<0.05. Mann-Whitney test showed significant different results for the first time patient requiring morphine as rescue analgesia between gabapentin group (161.5 [25 – 990] minutes) and placebo group (67.5 [10 – 371] minutes) with p<0.001. Nausea events on gabapentin group was reported lower than placebo group. Conclusion. Gabapentin 600 mg orally is more effective than placebo as preemptive analgesia for nonobstetric lower abdominal surgery. Nausea events were reported lower when gabapentin given as preemptive analgesia."

"Telah dilakukan penelitian untuk membandingkan keefektifan penambahan morfin 0.05 mg intratekal dan morfin 0.1 mg intratekal dalam hal kekerapan pruritus yang ditimbulkan oleh efek samping morfin intratekal dengan efek analgesia pasca bedah-nya tetap sama pada kasus bedah sesar dengan tehnik analgesia spinal.Disain : uji klinis acak tersamar ganda.Metode : 84 pasien yang menjalani bedah sesar dibagi 2 kelompok. Kelompok A sebanyak 42 orang mendapat 0.05 mg morfin dan kelompok B sebanyak 42 orang mendapat 0.1 mg morfin pada suntikan bupivakain 0.5% 10 mg intratekal. Selanjutnya dilakukan pemantauan nyeri menggunakan skor VAS, tekanan darah, laju nadi dan laju nafas pada jam ke 2, 4, 6, 8, 16 dan 24 pasca operasi. Selama pemantauan juga diamati kekerapan dan derajat pruritus. Penilaian pruritus dengan menggunakan skor VAS.Hasil : Pada kelompok A memberikan efek analgesia paska bedah yang tidak berbeda bermakna dengan kelompok B dalam 24 jam (p X0.05 ). Sedangkan kekerapan pruritus pada kelompok A dan kelompok B masing-masing 16.7% dan 40.5% (p<0.05). Derajat pnuitus ringan dan sedang pada kelompok A didapat 7% dan 0%. Sedangkan pada kelompok B pruritus ringan 35,7 % dan pruritus sedang 4.8 %. Dan kedua kelompok tidak ada yang mengalami pruritus berat.Kesimpulan : morfin 0.05 mg intratekal lebih efektif menurunkan kekerapan pruritus dibanding morfin 0.1 mg intratekal tetapi menghasilkan efek analgesia pasca bedah yang sama pada bedah sesar dengan analgesia spinal.

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This study compared the quality of analgesia and the incidence and degree of pruritus of 0.1 mg morphine intrathecally to 0.05 mg intrathecal morphine in patients undergoing Caesarean section.

Design: randomized and double-blinded study

Method: 84 patients who underwent Caesarean section were divided randomly into two groups. 42 patients in group A received intrathecal morphine 0.05 mg and group 13, 42 patients, received 0.1 mg morphine intrathecally in addition to a standard intrathecal dose of 10 mg bupivacaine 0.5% heavy. The quality of analgesia was assessed using Visual Analogue Score ( VAS) and the incidence and degree of pruritus were recorded during the first-24 hour postoperatively.

Result: there was no statistically significant difference in the quality of analgesia between the two groups (p > 0.05 ). The incidence of pruritus in group A and group B was 16.7% and 40.5% respectively (p<0.05 ). The degree of pruritus in group A were mild : 7% and moderate : 0% while in group B mild : 35.7% and moderate 4.8%. There was no severe pruritus in the two groups.

Conclusion : 0.05 mg intrathecal morphine significantly reduced the incidence of pruritus compared to 0A mg intrathecal morphine while there was no significant difference statistically in the quality of analgesia in the two groups."

"Latar belakang: Pemakaian heroin masih cukup tinggi di Indonesia. Tesis ini membahas tentang pengaruh penambahan natrium florida pada penyimpanan sampel darah yang mengandung heroin ( 6 monoacetylmorphine dan morfin ) di kulkas suhu 5°C - 15°.Metode: Penelitian ini merupakan penelitian analitik eksperimental dalam lingkungan yang terkontrol. Terhadap 8 subjek penelitian diambil darahnya sebanyak 9 ml yaitu yang menggunakan heroin 30 menit hingga 3 jam sebelum pengambilan darah. Kemudian 9 ml darah dibagi menjadi 3 tabung, masing- masing tabung 3 ml. Tabung pertama langsung diperiksa kadar 6 monoacetylmorphine dan morfin menggunakan Gas Choromatography Mass Spectrometry. Tabung kedua yaitu darah dengan natrium florida dan tabung ketiga darah tanpa natrium florida disimpan dikulkas suhu 5°C - 15°C selama 3 hari. Hasil: Pada pemeriksaan sampel hari pertama terhadap zat 6 monoacetylmorphine tidak ditemukan adanya zat tersebut. Karena pada kedelapan sampel , 6 monoacetylmorphinenya telah berubah menjadi morfin. Tetapi 6 monoacetylmorphine ini tetap ada hingga hari ketiga pada 50% sampel yang disimpan dengan natrium florida. Rata-rata kadar morfin hari pertama adalah 860,2 ± 669,5 ng/ml menurun pada hari ketiga menjadi 656,6 ± 425,8 ng/ml ( sampel dengan penambahan natrium florida) , 448,2 ± 270,7 ng/ml ( sampel tanpa penambahan natrium florida). Rata-rata perbedaan antara sebelum dan sesudah penyimpanan pada sampel yang ditambahkan natrium florida adalah 203,6 ± 252,4 ng/ml dengan signifikansi (p) = 0,057. Rata-rata perbedaan antara sebelum dan sesudah penyimpanan pada sampel tanpa penambahan natrium florida adalah 411,9 ± 475,2 ng/ml dengan signifikansi (p) = 0,044. Kesimpulan Dengan penambahan natrium florida dapat mencegah perubahan 6 monoacetylmorphine menjadi morfin pada 50% sampel penelitian. Pada sampel yang disimpan dengan natrium florida, tidak ada perbedaan bermakna antara kadar morfin sebelum dan sesudah penyimpanan selama 3 hari dikulkas suhu 5°C - 15°C. Pada sampel yang disimpan tanpa natrium florida , terdapat perbedaan yang bermakna antara kadar morfin sebelum dan sesudah penyimpanan selama 3 hari dikulkas suhu 5°C - 15°C.

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Background: Heroin consumption is still quite high in Indonesia. This study is to discuss the effect of adding sodium fluoride to the storage of blood samples containing heroin (6 monoacetylmorphine and morphine) in a refrigerator with a temperature of 5°C to 15°C.

Methods: This study is an experimental analysis in a controlled environment. To the 8 subject of study, 9 ml of blood was drawn who was using heroin 30 minutes to 3 hours before blood sampling. This 9 ml of blood were then saved into 3 tubes of 3 ml each. The first tube was directly examined for the levels of 6 monoacetylmorphine and morphine using Gas Choromatography-Mass Spectrometry. The second tube of blood with sodium fluoride and the third tube of blood without sodium fluoride were stored in refrigerator of 5°C to 15°C for 3 days.

Results: On the first day examinations, 6 monoacetylmorphine were not found, because all of the samples, 6 monoacetylmorphine has changed to morphine. But this 6 monoacetylmorphine remains until the third day in 50% of samples stored with sodium fluoride. Average concentration of morphine in the first day was 860.2 ± 669.5 ng/ml and decreased to 656.6 ± 425.8 ng/ml on the third day (samples with the addition of sodium fluoride), and to 448.2 ± 270.7 ng / ml (sample without the addition of sodium fluoride). The average difference between before and after storage in the samples added with sodium fluoride is 203.6 ± 252.4 ng/ml with significance of (p) = 0.057. The average difference between before and after storage in the samples without the addition of sodium fluoride was 411.9 ± 475.2 ng/ml with significance (p) = 0.044.

Conclusion The additions of sodium fluoride prevent changes of 6 monoacetylmorphine into morphine in 50% of the study sample. In samples stored with sodium fluoride, there is no significant difference between the levels of morphine before and after storage for 3 days in refrigerator with temperature of 5°C to 15°C. In the samples stored without sodium fluoride, while there is a significant difference between the levels of morphine before and after storage for 3 days in refrigerator temperature of 5°C to 15°C."

"ABSTRAKLatar Belakang: Nyeri pascaoperasi meningkatkan morbiditas, komplikasi pulmonal dan meningkatkan lama perawatan di rumah sakit. Teknik anestesia perioperatif dapat meningkatkan manajemen nyeri dan tingkat kepuasan pasien. Anestesia epidural dapat dikombinasikan dengan ajuvan untuk meningkatkan kualitas analgesia, memperpanjang durasi analgesia, mengurangi kebutuhan opiod dan efek sampingnya. Morfin memberikan kualitas analgesia yang baik tapi berkaitan dengan sering munculnya efek samping. Deksametason merupakan glukokortikoid yang dapat digunakan sebagai ajuvan anestesia epidural. Penelitian ini mencoba mengetahui perbandingan efektivitas penambahan ajuvan deksametason 8 mg dan morfin 2 mg pada bupivakain 0,125 12,5 mg epidural untuk analgesia pascaoperasi ekstremitas bawah.Metode: Penelitian ini merupakan uji klinik acak tersamar ganda untuk menilai efektivitas penambahan ajuvan deksametason 8 mg dan morfin 2 mg pada bupivakain 0,125 12,5 mg epidural untuk analgesia pascaoperasi ekstremitas bawah. Setelah mendapat izin komite etik dan informed consent sebanyak 64 subyek dengan consecutive sampling, subyek dirandomisasi menjadi dua kelompok untuk mendapatkan regimen epidural bupivakain 0,125 12,5 mg deksametason 8 mg kelompok bupivakain-deksametason dan bupivakain 0,125 12,5 mg morfin 2 mg pascaoperasi kelompok bupivakain-morfin . Subyek kemudian mendapatkan anestesia umum tanpa pemberian regimen epidural intraoperatif. Sesaat sebelum operasi belum selesai subyek diberikan parasetamol 1 gr iv. PCA morfin pascaoperasi diberikan bila VAS >4. Pasien dilakukan penilaian kebutuhan opioid, saat pertama membutuhkan analgesia tambahan, rerata derajat nyeri dan efek samping analgesia epidural pada kedua kelompok dalam 24 jam pertama pascaoperasi.Hasil: Kebutuhan opioid 24 jam pascaoperasi, saat pertama membutuhkan analgesia tambahan dan rerata derajat nyeri 24 jam pascaoperasi antara kedua kelompok didapatkan hasil tidak berbeda bermakna dengan nilai p 0,701, 0,729, dan 0,817. Kejadian mual/muntah didapatkan pada kelompok bupivakain-morfin 1,6 .Simpulan: Penambahan ajuvan deksametason 8 mg memiliki efektivitas yang sama dengan penambahan morfin 2 mg pada bupivakain 0,125 12,5 mg epidural untuk analgesia pascaoperasi ekstremitas bawah. Dosis deksametason 8 mg tidak berkaitan dengan timbulnya efek samping.Kata Kunci: ekstremitas bawah, pascaoperasi, epidural, bupivakain, morfin, deksametason, nyeri

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ABSTRACTBackground Post operative pain enhances morbidity, pulmonary complications and increases hospital length. The technique of perioperative anesthesia can improve pain management and patient satisfaction. Epidural anesthesia can be combined with adjuvants to improve the quality of analgesia, prolong the duration analgesia, reduce opioid requirements and side effects. Morphine provides good quality analgesia but it associated with adverse effects. Dexamethasone is a glucocorticoid that can be used as an adjuvant of epidural anesthesia. This study attempt to determine the effectiveness comparison of dexamethasone 8 mg and morphine 2 mg addition as adjuvants in bupivacaine 0,125 12,5 mg epidural for post operative analgesia of the lower extremity.Methods In this double blinded randomized clinical trial, we evaluate the effectiveness of adjuvant addition of dexamethasone 8 mg and morphine 2 mg in bupivacaine 0,125 12,5 mg epidural for post operative analgesia of the lower extremity surgery. After obtaining permission from the ethic committee and informed consent, a total 64 subjects with consecutive sampling were randomly allocated to two groups to receive a total volume of 10 ml epidural plain bupivacaine 0,125 12,5 mg with either 8 mg dexamethasone in the bupicaine dexamethasone group or 2 mg morphine in bupivacaine morphine group. Subjects then receive general anesthesia without epidural regimen administration intraoperatively. Shortly before the end of operation subjects were given intravenous paracetamol 1 gr. Patient Controlled Analgesia PCA of morphine was given when Visual Analog Scale VAS 4. Post operative opioid consumption, the time to first analgetic requirement, pain score and adverse effects in both group were recorded within the first 24 hours postoperatively.Result Post operative opioid consumption, the time to first analgetic requirement and pain score between the two groups showed no significant difference with p value respectively 0.701, 0.729 and 0.817. The incidence of nausea vomiting was found in the bupivacaine morphine group 1,6 .Conclusion The addition of dexamethasone 8 mg had the same effectiveness as morphine 2 mg in bupivacaine 0,125 12.5 mg epidural for post operative analgesia in the lower extremity surgery. Dosage of dexamethasone 8 mg was not associated with adverse events.Keywords lower extremity, post operative, epidural, bupivacaine, morphine, dexamethasone, pain "