EFEKTIVITAS KETAMIN MORFIN DIBANDINGKAN MORFIN DALAM PATIENT-CONTROLLED ANALGESIA UNTUK MENURUNKAN TOTAL DOSIS MORFIN DAN VISUAL ANALOG SCALE PASCABEDAH LAPAROTOMI DI RS SANGLAH

TESIS

Abstract

By : dr. Pande Nyoman Kurniasari

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Faculties : Fakultas Kedokteran

Department : PS. ANESTESIOLOGI DAN REANIMASI

Introduction: Laparotomy may cause moderate to severe pain in 48 hours after surgery, so adequate pain management is needed. One way to do so is by using ketamine in patient controlled analgesia (PCA) morphine. The study aims to evaluate the effectiveness of patient control analgesia (PCA) morphine-ketamine combination compared to patient control analgesia (PCA) morphine in patient to lower total dose of morphine and pain intensity with VAS (Visual Analog Scale) in post laparotomy patients. Materials and methods: This research is an experimental clinical trial. Screening subjects using consecutive sampling technique with a group of 58 subjects of physical status ASA I and II who underwent general anesthesia. Patients were divided into 2 groups. Group A was given combination of ketamine (1mg/ml) in PCA morphine (1mg/ml), while group 2 received only morphine by PCA. Dose of morphine and the pain scale with VAS were measured 6 hour, 12 hour, and 24 hour postoperatively. Characteristics of the samples were tested for normality by the Shapiro-Wilk. The collected data then tested with Mann Whitney test and t-test with significance level of P?0,05. Result: Total dose of morphine in the first 24 hours postoperatively at morphine-ketamine group (5,10,8) mg is lower than morphine-only group (6,50,9) mg with p<0,001. VAS silence at 6 hour postoperative in morphine-ketamine group (13,44,8) mm is lower than morphine (17,94,1) mm with a value of P?0,05. VAS silence 12 hour postoperative, morphine-ketamine group (10,72,6) mm is lower than morphine (12,85,3) mm with value of P?0,05. VAS move 6 hour postoperative morphine-ketamine group (24,85,1) mm is lower than morphine (28,75,2) mm with a value of P?0,05. VAS silence 12 hour postoperative, morphine-ketamine group (185,6) mm is lower than morphine (23,16,0) mm with value of P?0,05. VAS move 24 hour postoperative, morphine-ketamine group (95,6) mm is lower than morphine (12,85,3) mm with value P?0,05. Conclusions: addition of ketamine (1mg/ml) in PCA morphine (1mg/ml) in post laparotomy lower total morphine requirements at 24 hours compared to PCA morphine. In decreasing postoperative pain, adding ketamine in PCA morphine is decreasing VAS silent 6 hours and 12 hours postoperatively and VAS move 6 , 12 hours, and 24 hours postoperatively

Keyword : general anesthesia, laparatomy, PCA ketamine-morphine, morphine requirements, visual analogue scale

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