MANAJEMEN NYERI

SIGIT SUTANTO
DEPT ANESTESI DAN TERAPI INTENSIF
RS BHAYANGKARA ANTON SUDJARWO
PONTIANAK
 Pain – the 5th vital sign
Pain is "an unpleasant sensory and emotional
experience associated with actual or potential tissue
damage, or described in terms of such damage“ ~
IASP 1
Pain should be considered the “fifth vital sign” 2

1.
2.
Classification of Chronic Pain, Second Edition (Revised). IASP. 2011. Available from: http://www.iasp-
3. pain.org/files/Content/ContentFolders/Publications2/ClassificationofChronicPain/Part_III-PainTerms.pdf J Intraven Nurs. 2001 Mar-Apr;24(2):85-94.
4. The Joint Commission. Approaches to Pain Management: An Essential Guide for Clinical Leaders, Second Edition. Illinois; 2010. Available from:
http://www.jointcommissioninternational.org/approaches-to-pain-management-an-essential-guide-for-clinical-leaders- second-edition/approaches-to-pain-management-an-essential-guide-for-
clinical-leaders-second-edition-pdf-book-/ [accessed October 13th 2016]
Joint Commission International. Joint Commission International Accreditation Standards for Hospitals, Fifth Edition. 2013. Available from:
http://www.jointcommissioninternational.org/assets/3/7/Hospital-5E-Standards-Only-Mar2014.pdf [accessed October 13th
2016]
ANALGESIC MECHANISM
 LONG-TERM CONSEQUENCES OF ACUTE PAIN:
POTENTIAL FOR PROGRESSION TO CHRONIC PAIN

P CNS
Surgery or injury causes
Peripheral Neuroplasticity
inflammation Nociceptive
Fibers Hiperactivity

ACUTE PAIN CHRONIC PAIN

CNS = central nervous system.

Woolf CJ. Ann Intern Med. 2004;140:441-451. Petersen-Felix S, Curatolo M. Swiss Med Weekly.
2002;132:273-278. Woolf CJ. Nature.1983;306:686-688. Woolf CJ, et al. Nature. 1992;355:75-78.
19
WFSA STEP LADDER

Strong opioids
by injection,
local
Opioids
by decreases) NSAIDs
anesthesia

mouth (as pain

Aspirin and
 Behavioral Pain Scale (BPS)

Foto pasien di icu utk assessment ini >>

Critical-Care Pain Observation Tool (CPOT)

 Use of the CPOT can increase nurse’s sensitivity to pain in non-conscious patients
and drive them to track and perform pain management.
Noghabi AA, et al Nurses Use of Critical Care Pain Observational Tool in Patients with Low
Consciousness; OM Journal [2015], Vol. 30, No. 4: 276–282
Skala nyeri berbagai kondisi pasca operasi

Obsgin

• SC : sayatan Fannestiel (segmen bawah): 4

• SC : sayatan klasik : 7
• Prosedur daerah vulva : 7-8
• Kuretase : 3
• Histerektomi : 8
• Laparaskopi : 3-4
• MOW : 3-5
UROLOGI

• TURP : 1-3
• Operasi ginjal terbuka, cystectomy : 10
• Operasi daerah penis : 5
• Open prostat : 8
BEDAH UMUM

• FAM, biopsi : 3-4

• Hemoroidektomi : 9
• Herniorafi : 4-6
• Mastektomi : 6-8
• Op empedu, Whipple : 7-9
• Eksisi STT superfisial : 2-3
ORTOPEDI

• Eksisi ganglion : 2-4

• Op daerah pelvis (ORIF) : 9
• ORIF femur : 5-8
• Hip arthroplasty : 7
• Knee arthroplasty : 7
• Repair ligamen : 4
• ORIF extremitas atas, clavicula : 5-8
Prinsip Pain Management : Multimodal Analgesia
Golongan Opioid :
- Fentanyl
- Morfin
- Pethidine
- Tramadol
- Codein
- Hydromorphone

- e/s : depresi nafas, hipotensi, sedasi

Golongan NSAID:
- Ketorolac
- Ketoprofen
- Dexketoprofen
- Ibuprofen
- Mefenamic acid

e/s : peptic ulcer, nefrotoxicity, disrupt the

coagulation cascade
Dexmedetomidine
 α-2 receptor agonist
 Symphatolitic, sedative, amnestic, analgesic
 Minimally effect of respiratory drive
 Lighter sedation
 Less delirium
 Potential risk : hypotension, bradycardia

Manpreet K, et al Current role of dexmedetomidine in clinical anesthesia and intensive care,

Anest Essay Res. 2011 Jul-Dec; 5(2): 128–133
Afonso J, et al .  Dexmedetomidine: current role in anesthesia and intensive care.62(1):118-33
Analgesic combination :
Opioid, α-2 agonist, Paracetamol
• Male, 53 years old, 80 kgs, CAD patient undergone CABG
• Postoperative 1st day
TAKE HOME MESSAGES :

• Nyeri merupakan indera ke-5

• Kenali dan nilai skala nyeri secara dini
• Nyeri akut yang tidak tertangani dengan baik akan
menjadi nyeri kronik
• Prinsip penanganan nyeri : rasional dan multimodal
• Penanganan nyeri : individual
TERIMA KASIH