Perbandingan antara Tramadol 2 mg/kgBB dan Fentanil 2 mg/kgBB Intravena Sebagai Analgetik Intraoperatif pada Operasi Laparotomi Ginekologis; Pengaruhnya terhadap Skor PRST - Kurniawan, Arief; Pratiwi, Nur Pudyastuti (Majalah Kedokteran Bandung, 2017)
Perkembangan dan kemajuan teknologi serta ilmu pengetahuan telah mendorong pelaksanaan pelayanan kesehatan yang lebih efektif dan lebih ekonomis dibanding dengan cara yang lazim dikerjakan. Telah dilakukan penelitian terhadap 32 pasien operasi laparotomi ginekologis yang dibagi menjadi dua kelompok. Kelompok Tramadol (n=16) diberikan tramadol 2 mg/kgBB (pengenceran akuabides sampai 10 mL) lewat jalur infus selama satu menit, sedangkan pada kelompok Fentanil (n=16) diberikan fentanil 2 µg/kgBB dengan cara yang sama. Lima menit kemudian diberikan propofol 2 mg/kgBB, atrakurium 0,5 mg/kgBB, enfluran 2 volume %, N2O:O2=2 L/menit:2 L/menit. Setelah tiga menit dilakukan laringoskopi intubasi. Pasien diventilasi kendali dengan mode ventilator IPPV. Operasi dilaksanakan bila kedalaman anestesi tercapai berdasar atas skor PRST (P=systolic arterial pressure, R=heart rate, S=sweat, dan T=tears) 2 sampai dengan 4. Analgetik pertolongan 50 µg fentanil diberikan bila skor PRST lebih dari 4. Analgetik postoperatif 30 mg ketorolak dan antimuntah 10 mg metoklopramid diberikan saat jahit kulit. Pencatatan tekanan darah, laju nadi, saturasi O2, dan skor PRST dilakukan sebagai berikut: T0 = penderita tiba di kamar operasi, T1= preintubasi, T2= satu menit setelah intubasi, T3= satu menit setelah insisi, T4 dan seterusnya diukur tiap 15 menit sampai selesai operasi. Pasien diekstubasi setelah pernapasan adekuat. Skala sedasi dan muntah dinilai setiap 15 menit setelah ekstubasi selama dua jam. Dari hasil penelitian didapatkan skor PRST mulai T1 sampai T12 secara statistis tidak berbeda bermakna antara kelompok tramadol dan fentanil (p>0,05). Kedua kelompok mengalami peningkatan skor PRST satu menit setelah intubasi. Skor PRST dipertahankan antara 0 sampai 2. Pada kelompok tramadol dan fentanil masing-masing satu orang mendapatkan analgetik pertolongan fentanil 50 µg karena skor PRST 5. Tidak ditemukan perbedaan skala sedasi dan muntah antara dua kelompok perlakuan. Penelitian ini menunjukkan tramadol 2 mg/kgBB dibanding dengan fentanil 2 µg/kgBB sebagai analgetik intraoperatif pada operasi laparotomi ginekologis memberikan pengaruh yang sama terhadap skor PRST. Kata kunci: Analgetik intraoperatif, fentanil, laparotomi ginekologis, skor PRST, tramadol Comparison of Intravenous Tramadol 2 mg kgBW-1 and Fentanyl 2 mg.kgbw-1 As Intraoperative Analgetic for Gynecologic Laparotomy; Its Effects on PRST Score The development and improvement of technology and sciences influence the effectivity and economic of health care. This study was done on 32 patients who undergoing gynecologic laparotomy. The sample was divided into 2 groups, consisted of 16 patients each group. The tramadol group was given 2 mg.kgbw-1 tramadol (diluted to 10 mL) via infuse line over one minute whereas the fentanyl group was given 2 µg.kgbw-1 fentanyl by the same procedure as tramadol. Inductions was done five minutes later with 2 mg.kgbw-1 propofol, 0.5 mg.kgbw-1 atracurium, and maintenance anesthesia with 2 vol.% enflurane, 50% O2 and 50% N2O at flow rate 4 L/minutes. After three minutes the patient was intubated and ventilated by using control mode. Surgery had performing when depth of anesthesia achieved with PRST (P=systolic arterial pressure, R=heart rate, S=sweat, and T=tears) scored 2 to 4. Rescue analgetic with 50 mcf fentanyl if the PRST score more than 4. Analgetic postoperative 30 mg ketorolac and antiemetic 10 mg metoclopramide were given intravenously during skin closure. Blood pressure, heart rate, oxygen saturation and PRST score were recorded at T0=patient on arrival in theatre, T1=preintubation, T2=one minute after intubation, T3=one minute after incision, T4 and so on were recorded every fifteen minutes until the end of surgery. Extubation was done when patient breath adequately. Sedation scale and incidence of vomiting were evaluated every fifteen minutes for two hours after extubation. The result showed that PRST scores from T1 to T12 were statistically not significant in tramadol group and fentanyl group (p>0.05), but the PRST scores increasing significantly one minute after intubation in both groups. The PRST scores were between 0 to 2. Rescue analgetic was given to one patient in tramadol group and fentanyl group with PRST scored 5. Sedation scale and incidence of vomiting were statistically not significant in both groups. This study concluded that 2 mg.kgbw-1 tramadol and 2 µg.kgBB-1 fentanyl as an intraoperative analgetic during gynecologic laparotomy have the same PRST scores. Key words: Fentanyl, gynecologic, intraoperative analgetic, laparotomy, PRST score, tramadol