1. Parasetamol intravena dapat digunakan sebagai alternatif pengganti
ketorolak untuk penanganan nyeri paska pembedahan seksio sesaria, terutama pada pasien-pasien dengan adanya kontraindikasi pemberian obat ketorolak.
2. Parasetamol dan ketorolak dapat digunakan sebagai terapi adjuvant pada opioid untuk penanganan nyeri paska pembedahan.
3. Perlu dilakukan penelitian lebih lanjut dengan jumlah sampel yang lebih
banyak untuk menilai efek analgetik parasetamol dan ketorolak dengan pemberian per 6 jam untuk mendapatkan hasil yang lebih bermakna apakah memang pemberian kedua obat diatas cukup diberikan per 6 jam.
4. Perlu dilakukan penelitian lebih lanjut untuk meneliti penggunaan
parasetamol untuk penanganan nyeri paska pembedahan pada pasien dengan jenis operasi yang lain, dimana pasien dengan kontraindikasi pemberian ketorolak.
5. Perlu dilakukan penelitian lebih lanjut untuk meneliti penggunaan
kombinasi parasetamol dan ketorolak untuk penanganan nyeri paska pembedahan, sehingga bisa menyamai efek analgetik dari morfin.
DAFTAR PUSTAKA
1. Morgan GE, Mikhail MS, Murray MJ. Pain Managament. In : Morgan GE,
editor. Clinical Anesthesiology, 4th
2. Rawal N, Fischer HBJ, Ivani G, Andreas JD, Mogensen T, Narchi P, et al. Post
operative pain management – good clinical practice. European Society of Regional Anaesthesia. Sweden, 2008.
ed. Lange Medical Books/McGraw-Hill ; 2006. p. 359-412.
3. Stoelting RK, Hillier SC. Pain. In : Pharmacology & Physiology in Anesthetic Practice, 4th
4. Weis OF, Sriwatanakul K, Alloza JL, Weintraub M, Lasagna L. Attitudes of
patients, housestaff, and nurses toward postoperative analgesic care. Anesth Analg. 1983 ; 62 : 70–4.
ed. Lippincott Williams & Wilkins ; 2006. p.707-17.
5. Melzack R, Abbott FV, Zackon W, Mulder DS, Davis MW. Pain on a surgical
ward : a survey of the duration and intensity of pain and the effectiveness of medication. Pain. 1987 ; 29 : 67–72.
6. Forrest JB, Heitlinger EL, Revel S. Ketorolak for post operative pain
management in children. Drug Safety. May 1997 ; 16(51) : 309-29.
7. Yee JP, Koshiver JE, Allbon C, Brown CR. Comparison of intramuscular
ketorolak tromethamine and morphine sulfate for analgesia after major surgery. Pharmacotherapy. 1986 ; 6 : 253– 61.
8. O’Hara DA, Fragen RJ, Kinzer M, Pemberton D. Ketorolak tromethamine as
compared with morphine sulphate for treatment of post-operative pain. Clin Pharmacol Ther. 1987 ; 41 : 556–61.
9. Kenny GN. Potential renal, haematological and allergic adverse effects
associated with nonsteroidal anti-inflammatory drugs. Drugs and Pharmacology. 1992 : 44(Suppl 5) : 31– 6.
10.Cashman J, McAnulty G. Nonsteroidal anti-inflammatory drugs in perisurgical
pain management : mechanism of action and rationale for optimum use. Drugs and Pharmacology. 1995 ; 49 : 51–70.
12.Varrassi G, Marinangeli F, Agro F, Aloe L, Cillis PD, Nicola AD, et al. A double-blinded evaluation of propacetamol versus ketorolak in combination with patient-controlled analgesia morphine : analgesic efficacy and tolerability after gynecologic surgery. Anesth Analg. 1999 ; 88 : 611– 6.
13.Munishankar B, Fettes P, Moore C, McLeod GA. A double blind randomized
controlled trial of paracetamol, diclofenac or the combination for pain relief after caesarean section. International Journal of Obstetric Anesthesia. 2008 ; 17 : 9-14.
14.Moller PL, Juhl GI, Champenois CP, Skoglund LA. Intravenous acetaminophen
(paracetamol) : comparable analgesic efficacy, but better local safety than its prodrug, propacetamol, for postoperative pain after third molar surgery. Anesth Analg. 2005 ; 101 : 90– 6.
15.Medicine Q&AS. What is the evidence to support the use of iv paracetamol for the treatment of pain? UK Medicines Information Pharmacists for NHS Healthcare Professionals. From the National Electronic Library for Medicines. August 2010.
16.Khajavi MR, Najafi A, Khahi MP, Moharari RS. Propacetamol and morphin in
postoperative pain therapy after renal transplantation. International Journal of Pharmacology. 2007 ; 3(2) : 183-6.
17.McQuay HJ, Poppleton P, Carroll D, Summerfield RJ, Bullingham RE, Moore
RA. Ketorolak and acetaminophen for orthopedic postoperative pain. Clin Pharmacol Ther. 1986 ; 39 : 89 –93.
18.Zhou TJ, Tang Jun, White PF. Propacetamol versus ketorolak for treatment of
acute postoperative pain after total hip or knee replacement. Anesth Analg. 2001 ; 92 : 1569-75.
19.Rusy LM, Houck CS, Sullivan LJ, Ohlms LA, Jones DT, McGill TJ, et al. A
double-blind evaluation of ketorolak tromethamine versus acetaminophen in pediatric tonsillectomy : analgesia and bleeding. Anesth Analg. 1995;80:226 –9.
20.Montgomery JE, Sutherland CJ, Kestin IG, Sneyd JR. Morphine consumption in
patients receiving rectal paracetamoland diclofenac and in combination. British Journal of Anaesthesia. 1996 ; 77 : 445-7.
21.Cobby TF, Crighton IM, Kyriakides K, Hobbs GJ. Rectal paracetamol has a
significant morphine-sparing effect after hysterectomy. British Journal of Anaesthesia. 1999 ; 83(2) : 253-6.
22.Aghamir SK, Mojtahedzadeh M, Alizadeh F, Pharm HK, Sadeghi M, Najafi A. Propacetamol versus tramadol for post-operative pain management after urologic surgery. The Internet Journal of Pharmacology, 1531 – 2976. 2011.
23.Mahernoor FW, Ruiz MR, White PF, Jones MB, Lagueruela RG, Terkonda RP.
Perioperative effects of oral ketorolak and acetaminophen in children undergoing bilateral myringotomy. Can J Anaesth. 1992 ; 39(7) : 649-54.
24.Fletcher D, Negre I, Barbin C, Francois A, Carreres C, Samii K, et al.
Postoperative analgesia with IV propacetamol and ketoprofen combination after disc surgery. Can J Anaesth. 1997 ; 44 : 479–85.
25.Sahar SM, Aouad M, Maya JI, Laudia RB, Ghada Khamar, Anis B. Diclofenac
and/or propacetamol for postoperative pain management after cesarean delivery in patients receiving patient controlled analgesia morphine. American Society of Regional Anesthesia and Pain Medicine. 2001 ; 26 : 310-5.
26.Bonica JJ, Loeser JD. History of pain concepts and therapies. In : Loeser JD,
editor. The Management of Pain, 3rd
27.Abraham SE, Schlicht CR. Chronic Pain Management. In : Barash PG, Cullen
BF, Stoleting RK, editors. Clinical Anesthesia, 4
edition. Lippincot William Wilkins ; 1990. p.2-15
th
28.Woolf CJ. Pain moving from symptom control toward mechanism-spesific
pharmacologic management. Annals of Internal Medicine. 2004 ; 140 : 441-51. edition. Philadelphia : Lippincott Williams and Wilkins ; 2001. p.1453-62
29.Umar N. Acute pain : management strategies that work. Pertemuan Ilmiah
Berkala (PIB) IX IDSAI. Medan ; 2002. p.421-29.
30.Stephen EA. Pain Pathway and Mechanisme. In : The Pain Clinic Manom, 2nd
31.Carr DB, Goudas LC. Acute Pain. The Lancet, volume 353 ; June 1999.
p.2051-8. edition, 2000.
32.Hurley RW, Wu CL. Acute postoperative pain. In : Miller RD, editors.
Anesthesia, 7th
33.Meyer RA, Ringkamp M, Campbell JN. Peripheral neural mechanism of
nociception. In : McMahon SB, Koltzenburg M, editors. Textbook of Pain, 5 ed. London : Churchill Livingstone ; 2005. p.2327-41.
th
34.Larkin R. Acute pain management ; scientific evidence. National Health and
35.Vanderah TW. Pathophysiology of Pain. The Medical Clinics of North America. Med Clin N Am. 2007 ; 91 : 1-12.
36.Australian and New Zealand College of Anaesthetists and Faculty of Pain
Medicine. In : Acute Pain Management : Scientific Evidence. Australian Government. National Health and Medical Research Council ; 2010. p.1-8.
37.SA Schug, Fry RA. Continuous regional analgesia incomparison with
intravenous opioid administration for routine pos operative pain control. Anaesthesia Clin Phar. 1994 ; 49(6) : 528 – 32.
38.Conn D, Murdoch J. Manajemen Nyeri Akut. In : Kedokteran Perioperatif.
Oxford University Press ; 2000. p.57-69.
39.Jensen MP, Martin SA, Cheung R. The meaning of pain relief in a clinical trial. The Journal of Pain. 2005 ; 6 (6) : 400-6.
40.Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings
and change scores : a reanalysis of two clinical trial of postoperative pain. The Journal of Pain. 2003 ; 4(7) : 401-7.
41.Fillingim RB. Pain measurement in humans. In : Holcroft A, Jaggar S, editors.
Core topics in pain. Cambridge University New York:IASP Press ; 2001. p.71-7. 42.Myles PS, Troedel S, Boquest M, Reeves M. The pain visual scale, is it linier or
nonlinier? Anesth Analg. 1999 ; 89 : 1517-20.
43.Tanra AH. Pengelolaan Nyeri Paska Bedah. Pertemuan Ilmiah Berkala (PIB) IX
IDSAI. Medan ; 2002 : 413.
44.Stephan AS, Haridas RAJ. Development and Organization Structure of an Acute
Pain Service in Mayor Teaching Hospital. The Acute Pain Service at Ancklan Hospital Publication and Guideline. 1999. p.8 – 13.
45.Gottschalk A, Smith DS. New concepts in acute pain therapy : preemptive
analgesia. American Family Physician. 2001 ; 10 : 63.
46.Kelly DJ, Ahmad M, Sorin J. Brull MD. Preemptive analgesia II : recent
advances and current trens. Can J Anest. 2001; 48(11) : 1091-1101.
47.Sandkuhler J, Ruscheweyh R. Opioid and central sensititation : I. Preemptive
analgesia. European Journal of pain. 2005 ; 9 : 145-8.
48.Scottish Intercollegiate Guidelines Network (SIGN). Scotland :
National Health Service (NHS). Available from :
49.
50.
Moller P, Sindet P, Petersen CT, Juhl GI, Dillenschneider A, Skoglund LA. Onset of acetaminophen analgesia ; comparison of oral and intravenous routes after third molar surgery. British Journal of Anaesthesia. 2005 ; 94 (5) : 642–8. Bertolini A, Ferrari A, Ottani A, Guerzoni S, Tacchi R, Leone S
51.
52.
Byrant B, Knights K, Salerno E. Pharmacology for health professionals. Elsevier ; 2007 : 270.
53.Wikipedia. Paracetamol. The Free Encyclopedia. Available from :
. Retrieved April 22, 2010.
54.Montvale NJ, Thomson PDR. Acetaminophen. Physicians' Desk Reference, 63rd
55.Charles G, Gerald D, Bob R
ed. 2009. p.1915-6. 2010. 56. 57.
Hinz B, Cheremina O, Brune K. Acetaminophen (paracetamol) is a selective cyclooxygenase-2 inhibitor in man. Official publication of the Federation of American Societies for Experimental Biology. 2008 ; 22(2) : 383–90.
58.Roberts LJ II, Marrow JD. Analgesic-antipyretic and Antiinflammatory Agents
and Drugs Employed in the Treatment of Gout. In : Hardman JG, Limbird LE, editors. The Pharmacological Basis of Therapeutics, 10
Aronoff DM, Oates JA, Boutaud O. New insights into the mechanism of action of acetaminophen ; Its clinical pharmacologic characteristics reflect its inhibition of the two prostaglandin H2 synthases. Clin Pharmacol Ther. 2006;79(1):9–19.
th
59.
edition. New York : McGraw Hill ; 2001. p.687–731.
60.
Kis B, Snipes JA, Busija DW. Acetaminophen and the cyclooxygenase-3 puzzle : sorting out facts, fictions, and uncertainties. J Pharmacol Exp Ther. 2005 ; 315(1) : 1–7.
Chandrasekharan NV, Dai H, Roos KL
61.Hendrickson RG, Kenneth E
editors. Goldfrank's toxicologic emergencies. New York : McGraw-Hill ; 2006.
62.Borne, Ronald F. Nonsteroidal Anti-inflammatory Drugs. In : Principles of Medicinal Chemistry, 4th
63.
edition. NewYork : Williams & Wilkins ; 1995. p.544– 545.
García RLA, Hernández DS. 64. Therapy. 2000 ; 3(2) : 98–101. 65.
Rudolph AM. Effects of aspirin and acetaminophen in pregnancy and in the newborn. Arch Intern Med. 1981 ; 141(3 Spec No) : 358–63.
Lesko SM, Mitchell AA
66.Wikipedia. Ketorolak. The Free Encyclopedia. Available from :
http://en.wikipedia.org/wiki/Ketorolak.
pediatrics. 1999 ; 104(4) : p.39.
67.Uddin MB, Hossain M, Alam MM. Ketorolak and Pethidine in post-operative
pain relief. Bangladesh J Pharmacology. 2007 ; 2 : 35-42.
68.Kissin I. Pain Medicine Preemptive Analgesia at The Crossroad. Anesth Analg.
2005 ; 100 : 754 – 6.
69.Wikipedia. Gugur kandungan. The Free Encyclopedia. Available from :
http://id.wikipedia.org/wiki/Gugur-kandungan.
70.Delbos A, Boccard E. The morphine-sparing effect of propacetamol in
orthopedic postoperative pain. Journal of Pain and Symptom Management. Volume 10. May 1995 ; 279-86.
71.Sastroasmoro S, Rahardjo HRE, Taher A. Tonsilektomi pada anak dan dewasa.
HTA Indonesia. 2004 ; 1-25.
72.Mohta M, Agarwal D, Gupta LK, Tyagi A, Gupta A, Sethi AK. Comparison of
potency of ephedrine and mephentermine for prevention of post-spinal hypotension in caesarean section. Anesthesia and Intensive Care. Delhi India ; May 2008.