Apakah Epidural Preemtif Menghambat Stres Pembedahan dengan Sempurna?
Preemptive analgesia is initiating an analgesic regimen before the onset of the noxious stimulus. Damages to the tissue caused by surgical trauma generate noxious response conveyed to the central nervous system (CNS) by two pathways, neural pathway and circulatory pathway. This study is a double- bl...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Universitas Padjajaran
2013-09-01
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| Series: | Majalah Kedokteran Bandung |
| Subjects: | |
| Online Access: | http://journal.fk.unpad.ac.id/index.php/mkb/article/view/144 |
| _version_ | 1818757400701698048 |
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| author | Muh. Rumli Ahmad Tatang Bisri |
| author_facet | Muh. Rumli Ahmad Tatang Bisri |
| author_sort | Muh. Rumli Ahmad |
| collection | DOAJ |
| description | Preemptive analgesia is initiating an analgesic regimen before the onset of the noxious stimulus. Damages to the tissue caused by surgical trauma generate noxious response conveyed to the central nervous system (CNS) by two pathways, neural pathway and circulatory pathway. This study is a double- blinded clinical trial that included 48 patients undergoing lower extremity orthopedic surgery. The subjects were divided into two groups: group I (n=24) received 10 mL bupivacaine 0.25% from epidural route, and group II (n=24) received 10 mL NaCl 0.9% from epidural route as the control group before induction of anesthesia. Both groups were anesthetized under general anesthesia. Group I received 5 mL bupivacaine 0,5% every 90 minutes and group II received 5 mL NaCl 0,9 with similar time intraoperatively. Post-operatively, both groups received continuous bupivacaine 0,25% 4 mL/ hour until 24 hours after surgery. Measurements of cytokine levels: tumor necrosis factor-α (TNF-α), interleukin- 1β (IL-1β), IL-6 and IL-10 were done before induction of anesthesia, in the early post-operative period, at 4, 8, and 24 hours after surgery. Group I showed lower level proinflammatory cytokines level compared with group II but the difference was not statistically significant (p>0.05). The level of anti-inflammatory cytokine was higher in group I, but the difference was not statistically significant (p>0.05). Pain intensity at 4 hours, 8 hours, 24 jam hours post operative was lower significantly (p<0.05) Hemodynamic responses was lower in group I but not significant (p>0.05) excepst at early postoperative period (p<0.05). Generally, preemptive epidural analgesia was able to suppress the cytokine responses, but not completely. In conclusion, preemptive epidural analgesia is associated with better analgesia and better hemodynamic stability compared without preemptive epidural, but unable to suppress the production of proinflammatory and anti-inflammatory cytokines. |
| first_indexed | 2024-12-18T06:10:20Z |
| format | Article |
| id | doaj.art-79507646494f4d929f945f7103f79d46 |
| institution | Directory Open Access Journal |
| issn | 0126-074X 2338-6223 |
| language | English |
| last_indexed | 2024-12-18T06:10:20Z |
| publishDate | 2013-09-01 |
| publisher | Universitas Padjajaran |
| record_format | Article |
| series | Majalah Kedokteran Bandung |
| spelling | doaj.art-79507646494f4d929f945f7103f79d462022-12-21T21:18:25ZengUniversitas PadjajaranMajalah Kedokteran Bandung0126-074X2338-62232013-09-0145314715410.15395/mkb.v45n3.144Apakah Epidural Preemtif Menghambat Stres Pembedahan dengan Sempurna?Muh. Rumli Ahmad0Tatang Bisri1Departemen Anestesiologi, Terapi Intensif dan Manajemen Nyeri Fakultas Kedokteran Universitas Hasanuddin-RSUP Dr. Wahidin Sudirohusodo MakassarDepartemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin BandungPreemptive analgesia is initiating an analgesic regimen before the onset of the noxious stimulus. Damages to the tissue caused by surgical trauma generate noxious response conveyed to the central nervous system (CNS) by two pathways, neural pathway and circulatory pathway. This study is a double- blinded clinical trial that included 48 patients undergoing lower extremity orthopedic surgery. The subjects were divided into two groups: group I (n=24) received 10 mL bupivacaine 0.25% from epidural route, and group II (n=24) received 10 mL NaCl 0.9% from epidural route as the control group before induction of anesthesia. Both groups were anesthetized under general anesthesia. Group I received 5 mL bupivacaine 0,5% every 90 minutes and group II received 5 mL NaCl 0,9 with similar time intraoperatively. Post-operatively, both groups received continuous bupivacaine 0,25% 4 mL/ hour until 24 hours after surgery. Measurements of cytokine levels: tumor necrosis factor-α (TNF-α), interleukin- 1β (IL-1β), IL-6 and IL-10 were done before induction of anesthesia, in the early post-operative period, at 4, 8, and 24 hours after surgery. Group I showed lower level proinflammatory cytokines level compared with group II but the difference was not statistically significant (p>0.05). The level of anti-inflammatory cytokine was higher in group I, but the difference was not statistically significant (p>0.05). Pain intensity at 4 hours, 8 hours, 24 jam hours post operative was lower significantly (p<0.05) Hemodynamic responses was lower in group I but not significant (p>0.05) excepst at early postoperative period (p<0.05). Generally, preemptive epidural analgesia was able to suppress the cytokine responses, but not completely. In conclusion, preemptive epidural analgesia is associated with better analgesia and better hemodynamic stability compared without preemptive epidural, but unable to suppress the production of proinflammatory and anti-inflammatory cytokines.http://journal.fk.unpad.ac.id/index.php/mkb/article/view/144Cytokineshemodynamicpain intensitypreemptive epidural |
| spellingShingle | Muh. Rumli Ahmad Tatang Bisri Apakah Epidural Preemtif Menghambat Stres Pembedahan dengan Sempurna? Majalah Kedokteran Bandung Cytokines hemodynamic pain intensity preemptive epidural |
| title | Apakah Epidural Preemtif Menghambat Stres Pembedahan dengan Sempurna? |
| title_full | Apakah Epidural Preemtif Menghambat Stres Pembedahan dengan Sempurna? |
| title_fullStr | Apakah Epidural Preemtif Menghambat Stres Pembedahan dengan Sempurna? |
| title_full_unstemmed | Apakah Epidural Preemtif Menghambat Stres Pembedahan dengan Sempurna? |
| title_short | Apakah Epidural Preemtif Menghambat Stres Pembedahan dengan Sempurna? |
| title_sort | apakah epidural preemtif menghambat stres pembedahan dengan sempurna |
| topic | Cytokines hemodynamic pain intensity preemptive epidural |
| url | http://journal.fk.unpad.ac.id/index.php/mkb/article/view/144 |
| work_keys_str_mv | AT muhrumliahmad apakahepiduralpreemtifmenghambatstrespembedahandengansempurna AT tatangbisri apakahepiduralpreemtifmenghambatstrespembedahandengansempurna |