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Abstrak :
Handbook of Extemporaneous Preparation is a comprehensive and easy-to-follow guide to good practice in extemporaneous compunding. It incorporates the key findings and outputs from the UK National Advisory Board study, including advice on purchasing unlicensed medicines. It will be adopted as the standard for extemporaneous dispensing for NHS patients. Although the standards set out in this book are primarily written for implementation in NHS hospitals, the priciples should be equally applied across the profession internationally. -- Compounding of pharmaceutical formulations remains a core skill of pharmacists and is taught at undergraduate level. Written by experts in the field with input from the UK NHS Pharmaceutical Quality Assurance Committee, this book will be an invaluable reference for any clinical or procurement pharmacist, pharmacy technician or student involved with extemporaneous preparation

Abstrak :
Cancer pain management: is a multidisciplinary effort, where the use of drug is often greatly beneficial for the patient. Pain assessment using the visual analog scale (VAS) is very helpful. Mild pain can be managed using acetaminophen or non-steroid anti-inflammatory drugs (NSAIDs). Moderate pain can be treated using mild opioids, while severe pain is treated using strong opioids such as morphine. Administration of morphine is safe, with a dose that is titrated to reach the optimal dosage, and does not produce serious side-effects. Administration of laxatives to prevent constipation should commence since the. first administration of morphine.

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ABSTRAK
Pendahuluan: Keluhan nyeri paska total knee arthroplasty dilaporkan cukup tinggi sehingga meningkatkan penggunaan morfin paska operasi, memperlambat mobilisasi, meningkatkan biaya dan menurunkan angka kepuasan dari pasien. Preemptif analgesia Celecoxib dan Pregabalin dilaporkan memberikan hasil yang menjanjikan, namun belum banyak studi yang melaporkannya. Metode: Penelitian ini merupakan uji klinis acak tersamar ganda. Sebanyak 30 pasien dibagi secara acak kedalam 3 kelompok. Kelompok pertama mendapatkan preemptif analgesia kombinasi Celecoxib 400 mg dan Pregabalin 150 mg, Kelompok 2 mendapatkan Celecoxib 200 mg dan pregabalin 75 mg dan kelompok 3 diberikan placebo. Efektifitas dinilai dengan menghitung total konsumsi morfin paska operasi, penilaian VAS Score, latihan fungsional lutut dengan range of motion ROM dan mobilisasi.. Hasil: Terdapat perbedaan bermakna total konsumsi morfin paska operasi pada kelompok preemptif analgesia, dibandingkan placebo, Terdapat perbedaan bermakna derajat VAS antara kelompok preemptif analgesia dibanding placebo, namun tidak terdapat perbedaan bermakna antara kedua kelompok preemptif analgesia. Keluhan mual ditemukan pada 2 subjek di kelompok 1, 1 subjek di kelompok 2 dan 3. Kesimpulan: Pemberian preemptif analgesia celecoxib dan pregabalin efektif mengurangi nyeri akut paska operasi dan menurunkan penggunaan morfin paska operasi, Dianjurkan untuk menggunakan kombinasi celecoxib dan pregabalin sebagai preemptif analgesia pada total knee arthroplasty.

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ABSTRACT
Introduction Pain after Total Knee Arthroplasty reported high, therefore increase the use of morphine after surgery, slow mobilization, increase cost and decrease patient satisfactory. Preemptive analgesia celecoxib and pregabalin reported give the promising result, but not many studies have reported it. Method This study was double disordered clinical study. 30 patients divide randomly into 3 groups. The first group receive preemptive analgesia combination of celecoxib 400 mg and pregabalin 150 mg. The second receive celecoxib 200 mg and pregabalin 75 mg and third group receive placebo. Effectiveness in this study assessed with count total consumption of morphine after surgery, VAS Scoring, functional exercise of knee with ROM and mobilization. Result There was significant differences in count of total consumption of morphine after surgery in preemptive analgesia group, compared to placebo. There was significant difference in VAS degree between preemptive group and placebo, but no significant difference between two preemptive groups. Nausea found on 2 subjects in first group, 1 subject in second and third respectively. Conclusion Administration of preemptive analgesia celecoxib and pregabalin effective to decrease acute pain and reduce use of morphine after surgery. It is advisable to use a combination of celecoxib and pregabalin in total knee arthroplasty.

Abstrak :
Latar belakang : Penelitian ini membandingkan efek ropivakain hiperbarik 15 mg + morfin 0,15 mg dengan ropivakain hiperbarik 12 mg + morfin 0,15 mg untuk bedah sesar dengan analgesia spinal. Metode : Dilakukan secara acak tersamar Banda. Hipotesis yang dibuat adalah Ropivakain hiperbarik 12 mg dengan morfin 0,15 mg intratekal, mempunyai mula kerja hambatan sensorik dan motorik yang sama dengan ropivakain hiperbarik 15 mg ditambah morfin 0,15 mg intratekal, namun dengan masa kerja hambatan sensorik dan motorik lebih singkat, dan dapat digunakan untuk anestesia spinal pada bedah sesar. Sebanyak 66 wanita hamil yang akan menjalani beddah sesar, ASA I -- II diberikan ropivakain hiperbarik 15 mg + morfin 0,15 mg (n=33) atau ropivakain hiperbarik 12 mg + morfin 0,15 mg (n-33) dengan teknik blok subaraknoid. Perubahan blok sensorik diukur dengan tes pinprick, dan perubahan hambatan motorik diukur dengan modifikasi skala bomage, VAS diukur 3 kali. Basil : Tidak ada perbedaan bermakna pada data demografi kedua kelompok. Kelompok ropivakain 15 mg mempunyai penyebaran hambatan sensorik maksimal lebih tinggi (median [min-max]) : Th 4 (th 1 - 6) vs Th 5 (Th 2 -- 6), tidak ada perbedaan bermakna pada mula kerja hambatan sensorik (median [min-max]) : 3,2 mnt (2 - 5 mnt) vs 3,0 (1- 5 mnt), tidak ada perbedaan bermakna pada mula keija hambatan motorik (median [min-max]) : 3,3 mnt (1-10 mnt) vs 3 mnt (1-7 mnt), masa kerja hambatan sensorik lebih lama pada kelompok ropivakain 15 mg (median [min-max]) : 60 mnt (45 -120mnt) vs 52 mnt (30 - 103 mnt), masa kerja hambatan motorik lebih lama pada kelompok ropivakain 15 mg (median[min-max]) : 60 mnt (35-118 mnt) vs 57 mnt (32 -102 mnt), dan basil yang sama pada pengukuran VAS sebanyak 3 kali. Simpulan : Ropivakain hiperbarik 15 mg + morfin 0,15 mg dan ropivakain hiperbarik 12 mg + mofin 0,15 mg dapat digunakan untuk analgesia spinal untuk operasi bedah sesar.

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Background This study was designed to evaluate the effects of intrathecal hyperbaric ropivacaine 15 mg plus morln 0,15 mg and hyperbaric ropivacaine 12 mg plus morphine 0,15 mg in women undergoing cesarean section. Methods : This was a prospective, randomized, doubleblinded study. We hypothesized that hyperbaric ropivacaine 12 mg plus morphin 0,15 mg has the same onset of sensory and motoric block, with longer duration of sensory and motoric block with hyperbaric ropivacaine 15 mg plus morphine 0,15 mg. Sixtysix parturients, physical status ASA I - II were given either hyperbaric ropivacaine 15 mg plus morphine 0,15 mg (n=33) or hyperbaric ropivacaine 12 mg plus morphine 0,15 mg (n=33), for cesarean section with spinal analgesia. Changing of sensory block was assessed by pinprick test and motoric block was assessed by bromage score (modification). Visual analogue score was measured three times. Results : There were no significant differences in demographic variable between groups. Higher cephalic spread (median [range]) maximum block height to pinprick hyperbaric ropivacaine 15 mg compare hyperbaric ropivacaine 12 mg : Th 4 (th 1 - 6) vs Th 5 (Th 2 - 6), no significant difference of sensory block onset (median [range]) : 3,2 min (2 - 5 minutes) vs 3,0 (1 - 5 min), no significant difference of motoric block onset (median [range]) : 3,3 min (1-10 min) vs 3 min ( 1-7 min), longer sensoric block duration hyperbaric ropivacaine 15 mg compare to hyperbaric ropivacaine 12 mg (median [range]) : 60 min (45 -120min) vs 52 min (30 -- 103 min), longer motoric block duration in hyperbaric ropivacaine 15 mg compare hyperbaric ropivacaine 12 mg (median[range]) : 60 min (35-118 min) vs 57 min (32 - 102 min), and no significant difference in visual analogue score in three times measurements. Conclusion : Hyperbaric ropivacaine 15 mg plus morphine 0,15 mg and hyperbaric ropivacaine 12 mg plus morphine 0,15 mg are sufficient for spinal analgesia in patients undergoing cesarean section.

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[ABSTRAK
Pemeriksaan toksikologi forensik terdiri dari pemeriksaan kualitatif dan kuantitatif. Pemeriksaan menggunakan metode Biochip Array Technology merupakan metode baru dengan teknologi nano digunakan untuk pemeriksaan toksikologi forensik. Tujuan penelitian ini untuk mengetahui nilai diagnostik pemeriksaan morfin dan benzodiazepin menggunakan metode tersebut. Penelitian ini menggunakan desain penelitian potong lintang (Cross sectional), dengan sampel penelitian adalah seorang laki-laki atau perempuan berusia diatas 18 tahun sejumlah 20 orang yang diambil dengan cara Consecutive sampling pada bulan September 2014 di Puskesmas Johar Baru, Jakarta Pusat. Dari sampel tersebut yang diperiksa dengan GC/MS, 4 sampel terdeteksi positif morfin, dan 3 sampel terdeteksi benzodiazepin. Pemeriksaan dengan metode Biochip Array Technology, 4 sampel positif morfin, dan 6 sampel terdeteksi positif benzodiazepin. Hasil analisa uji diagnostik menunjukkan bahwa pemeriksaan morfin menggunakan metode tersebut memiliki sensitivitas sebesar 100 %, spesifisitas 100 %, nilai duga positif 100 % dan nilai duga negatif 100 %. Hasil uji diagnostik pemeriksaan benzodiazepin menggunakan metode tersebut adalah sensitivitas 100 %, spesifisitas 82,35%, nilai duga positif 50 % dan nilai duga negatif 100 %. Dapat disimpulkan bahwa metode ini sangat baik digunakan untuk pemeriksaan morfin sedangkan untuk pemeriksaan benzodiazepine kurang baik.

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ABSTRACT
Forensic toxicology examination consists of a qualitative and quantitative examination. Biochip Array Technology is a new method with nanotechnology used for Forensic toxicology examination. The aim is to know the identificcation value of Biochip Array Technology diagnostic test to forensic toxicology examination of Morphine and benzodiazepine in urine. Cross Sectional diagnostic study was applied to those who are male or female aged over 18 years old, 20 samples were taken consecutively in Agustus 2014 from primary health centres of Johar Baru, Jakarta Pusat. From these samples using the GC/MS, 4 samples are positive morphine, 3 samples are positive benzodiazepine. From Biochip Array Technology Examination, 4 samples are positive morphine, 6 samples are positive benzodiazepine. Diagnostic test analysis in morphine examination showed that Biochip Array Technology revealed 100 % sensitivity, 100 % specificity, 100 % positive predictive value, and 100 % negative predictive value. Diagnostic test analysis in benzodiazepine examination showed that Biochip Array Technology revealed 100 % sensitivity, 82,35 % specificity, 50 % positive predictive value and 100 % negative predictive value. It can be concluded that this method is reliable in morphine examination but only if the sample is controlled, while for benzodiazepine examination, this method is not reliable. , Forensic toxicology examination consists of a qualitative and quantitative examination. Biochip Array Technology is a new method with nanotechnology used for Forensic toxicology examination. The aim is to know the identificcation value of Biochip Array Technology diagnostic test to forensic toxicology examination of Morphine and benzodiazepine in urine. Cross Sectional diagnostic study was applied to those who are male or female aged over 18 years old, 20 samples were taken consecutively in Agustus 2014 from primary health centres of Johar Baru, Jakarta Pusat. From these samples using the GC/MS, 4 samples are positive morphine, 3 samples are positive benzodiazepine. From Biochip Array Technology Examination, 4 samples are positive morphine, 6 samples are positive benzodiazepine. Diagnostic test analysis in morphine examination showed that Biochip Array Technology revealed 100 % sensitivity, 100 % specificity, 100 % positive predictive value, and 100 % negative predictive value. Diagnostic test analysis in benzodiazepine examination showed that Biochip Array Technology revealed 100 % sensitivity, 82,35 % specificity, 50 % positive predictive value and 100 % negative predictive value. It can be concluded that this method is reliable in morphine examination but only if the sample is controlled, while for benzodiazepine examination, this method is not reliable. ]

Abstrak :
PT. Kimia Farma, Tbk, merupakan perusahaan BUMN Farmasi yang sudah lama berdiri di Indonesia, memiliki hak monopoli dalam importasi, produksi dan distribusi produk Tablet Morfin, produk ini merupakan produk yang wajib ada untuk kebutuhan pengobatan. Sangatlah penting bagi perusahaan untuk dapat mengamankan serta menganalisis rantai pasoknya, agar memiliki sistem rantai pasok yang baik. Tesis ini mempelajari dan mengevaluasi rantai pasok dan proses bisnis PT Kimia Farma, Tbk, dalam melakukan pasokan Tablet Morfin, dengan menggunakan analisis Focus Group Discussion (FDG), dan Fishbone, hasil analisis menunjukkan terjadinya ketidaksesuaian rantai pasok yang terjadi pada distributor Majapahit (Jakarta Pusat), yang memasok RS Kanker Dharmais, ketidaksesuaian berupa kekosongan produk dikarenakan beberapa akar penyebab, yaitu Lead Time yang lama, tidak adanya sistem Standard Operating Procedure (SOP) yang terintegrasi, tidak adanya sistem Teknologi Informasi terintegrasi, pengetahuan SDM mengenai regulasi kurang, dan perencanaan distribusi yang tidak tepat. ......PT. Kimia Farma Tbk, a pharmaceuticals state-owned company has established in Indonesia for many years, has a monopoly in the importation, production and distribution of Morphine tablets, this product is compulsory product for medication. It is important for companies to secure and analyze the supply chain, in order to have a good supply chain system. This thesis studied and evaluated supply chain and business process at PT Kimia Farma Tbk, in delivering Morphine Tablets to the customer, by using Focus Group Discussion (FDG), and Fishbone analysis, the results of the analysis showed the occurrence of mismatch of supply chain happens at distributor Majapahit (Jakarta Pusat), which supplies Dharmais Cancer Hospital, a mismatch in the form of zero stock because some of the root causes, some of the root causes are, Long Lead Time, lack of integrationsystem in the Standard Operating Procedure (SOP), No Integration on Information Technology systems, poor human resources knowledge on regulation, and improper distribution planning.

Abstrak :
Tujuan : dilakukan penelitian untuk membandingkan keefektifan morfin 0,05 mg intratekal plus ketorolak 30 mg intramuskular dengan morfin 0,1 mg intratekal untuk mencegah nyeri pasca bedah sesar dengan analgesia spinal bupivakain 0,5% 12,5 mg. Disain : uji klinis acak tersamar ganda. Metode : 96 pasien yang menjalani bedah sesar dibagi 2 kelompok. Kelompok A sebanyak 48 orang mendapat 0,05 mg morfin pada suntikan bupivakain 0,5% 12,5 mg intratekal plus ketorolak 30 mg intramuskular dan kelompok B sebanyak 48 orang mendapat 0,1 mg morfin pada suntikan bupivakain 0,5% 12,5 mg plus NaCi 0,9% 1 cc intramuscular. Selanjutnya dilakukan pemantauan nyeri menggunakan VAS, tekanan darah, frekuensi nadi, nafas dan efek samping pada jam ke 2, 4, 6, 8, 16 dan 24 pasca operasi. Hasil : kelompok A mempunyai efek analgesia yang setara dengan kelompok pada pemantauan jam ke 2 hingga ke 24 dan pa 0,05_ Efek samping pruritus, mual muntah kelompok A 14,6%, 2,1%, 2,1% sedangkan kelompok B 43,0%, 10,4%, 4,2%. Kesimpulan : morfin intratekal 0,05 mg plus ketorolak 30 mg intramuskular menghasilkan analgesia yang tidak berbeda bermakna dengan morfin 0,1 mg dan menurunnya efek samping pruritus, mual dan muntah pasca bedah sesar.

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Objective : this study was conducted to compare the effectiveness of 0,05 mg intrathecal morphine plus 30 mg intramuscular ketorolac with 0,1 mg intrathecal morphine for postoperative pain control after cesarean delivery under spinal analgesia with 12,5 mg of 0,5 % plain bupivacaine. Design : double blind, randomized clinical study Methods : 96 patients who underwent cesarean delivery, were divided into 2 groups. Group A : 48 patients got 0,05 mg intrathecal morphine at injection of 12,5 mg bupivacaine 0,5 % combined with 30 mg intramuscular ketorolac. Group B : 48 patients got 0,1 mg intrathecal morphine at injection of 12,5 mg bupivacaine 0,5 % plus NaCl 0,9 % intramuscular. All patients were observed and evaluated for the first 24 hours : the effectiveness of analgesia using VAS, BP, HR and RR. Result : group A have the same effectiveness of post operative pain control with group B during the observations. A significanty greater incidence of pruritus was observed in the group B receiving 0,1 mg of intrathecal morphine. Although no significant difference among groups was observed regarding the incidence of vomiting, there was a trend toward less vomiting with the use of smaller doses of morphine. Conclusion : a multimodal approach to pain control with the use of a combination drug ( 0,05 intrathecal morphine and 30 mg im ketorolac) have same quality of analgesia that provided with 0,1 mg intrathecal morphine but the incidence of side effects trend to decrease.

Abstrak :
ABSTRAK Latar Belakang: Manajemen nyeri pascabedah yang efektif dapat memberikan pemulihan cepat, mengurangi biaya perawatan dan tercapainya kenyamanan serta kepuasan pasien. Pemberian analgesia epidural dapat digunakan secara Continuous Epidural Infusion/ CEI. Epidural kontinu memberikan  derajat analgesia yang stabil, mencegah fluktuasi dalam meredakan nyeri dengan gangguan kardiovaskular minimal. Saat dilakukan chest physiotherapy pascabedah dengan pemberian CEI, pasien lebih kooperatif sehingga meningkatkan kepuasan pasien. Tujuan penelitian ini untuk mengetahui perbandingan efektivitas antara teknik CEI dengan IEB pada pemberian morfin 4 mg dan bupivakain 0.125%  per 24 jam. Metode: Penelitian uji klinik acak tidak tersamar ini melibatkan 36 subjek pascabedah abdomen bawah, urologi dan ginekologi  dari Januari sampai Maret 2018. Dilakukan consecutive sampling kemudian dibagi melalui  randomisasi menjadi 2 kelompok CEI dan IEB. Pada kelompok CEI mendapatkan morfin 4 mg + bupivakain 0,125% 60 mg (total volume 48 ml) kecepatan 2 ml/jam drip selama 24 jam, tanpa inisial bolus. Kelompok IEB, mendapatkan morfin 2 mg + bupivakain 0,125% 5 mg (total volume 4 ml) tiap 12 jam. Penelitian ini Membandingkan derajat nyeri istirahat dan bergerak pada menit ke-0, jam ke-6, jam ke-12 dan jam ke-24, saat pertama kali pasien membutuhkan analgesik tambahan  dan jumlah pemberian ketorolak dan efek samping analgesia epidural pada kedua grup dalam 24 jam pertama. Hasil: Kedua kelompok sama efektif dalam  mengontrol nyeri pascabedah secara klinis. Saat menit ke-0, jam ke-6, jam ke-12 dan jam ke-24 berdasarkan rentang NPS termasuk nyeri ringan-sedang, dengan nilai median derajat nyeri bergerak 2-3 dan derajat nyeri istirahat 1-2, meski tidak  ada perbedaan bermakna secara statistik. Simpulan : Tidak ada perbedaan efektivitas antara teknik CEI dengan IEB pada pemberian morfin 4 mg dan bupivakain 0.125%  per 24 jam.

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ABSTRACT Background: An Effective post-operative pain management can improve recovery period, reduce cost, and give comfort and satisfaction to the patient. Epidural analgesia can be given continuously (Continuous Epidural Infusion/ CEI) or intermittently (Intermittent Epidural Bolus/IEB). However, continuous epidural analgesia provides stable analgesia level. It prevents fluctuation in pain with minimal cardiovascular disruption. Patient with CEI is more cooperative in the effectiveness chest physiotherapy hence improve patient satisfaction. This study aims to compare the effectiveness between CEI and IEB for lower abdomen and urology post-operative epidural analgesia using of 4 mg morphine and bupivacaine 0125% in 24 hours. Methode: This study was a randomized control trial. 36 Subjects were taken from January to March 2018. Were selected consecutively randomized into two groups: In CEI group, morphine 4 mg + bupivacaine 0,125% 60 mg (total volume 48 ml) with speed 2 ml/hour in 24 hour) was given post-operatively, without initial boluses. In IEB group, morphine 2 mg + bupivacaine 0.125% 5 mg (total volume 4 ml)  was give every 12 hours. This study evaluate the degree of pain (rest and active condition) in 0 minute, 6 hour, 12 hour, and 24 hour post-operative, rescue analgesia time (ketorolac iv), and side effect of epidural analgesia in two groups within first 24 hour. Result: The effectiveness in controlling post-operative pain between two groups was similar. Clinically, pain in 0 minute, 6 hour, 12 hour, and 24 hour in two groups according to NPS range were classified as mild-moderate pain, with median value of pain degree (active condition) was 2-3 and pain degree (rest) was 1-2, although not statistically significant. Conclusion: There is no difference the effectiveness between CEI and IEB for lower abdomen and urology post-operative epidural analgesia using of 4 mg morphine and bupivacaine 0125% in 24 hours.

Abstrak :
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.

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ABSTRAK
Latar 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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ABSTRACT
Background 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