BACAAN JURNAL

Analgesia Pasca Operasi pada Modifikasi Radikal

Pasien Mastektomi Setelah Instilasi
Bupivakain Melalui Drainase Bedah

Nama
 Latar belakang
Modifikasi
Nyeri terjadi pada hingga 50%
Mastektomi Radikal
wanita yang menerima mastektomi
(MRM)

25 sampai 60% mengembangkan

40% wanita mengalami nyeri
nyeri pasca operasi kronis yang
pasca operasi akut persisten

Gangguan
Opioid pencernaan dan
mulas

bupivakain liposom 2
 Rasional penelitian ini

Minimally invasive procedures can

This will eliminate pain with the least
result in immediate pain relief in
side effects and at a minimal cost
patients undergoing mastectomy

Reducing the number of admissions

A rapid recovery and return early to
due to pain after mastectomy, early
domestic responsibilities
discharge, and narcotics reduction

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 Tujuan Studi

Untuk menentukan kemanjuran bupivakain

berangsur-angsur melalui drainase bedah
pada dasar luka dalam mengendalikan nyeri
pasca operasi setelah MRM dengan
membandingkan rata-rata durasi analgesia

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 Bahan dan metode
Randomized controlled trial (RCT) study with a
probability random sampling technique

Surgical Unit 1, Ward 3, Jinnah Postgraduate Medical

Centre, Karachi

November 2020 to April 2021

The Ethical Review Board

(NO.F.2-81/2020-GENL/44820/JPMC) dated July 22,
2020 5
 Kriteria Inklusi

The American Society of

Female patients aged between Anesthesiologists (ASA)
45 to 60 years physical status classification
system I or II

Undergoing unilateral MRM

Negative PCR results in the last
with axillary lymph node
48 hours
dissection

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 Kriteria Pengecualian
Pregnant females

Allergy to the local anesthetic drug

Patients with weight less than 30 kilograms

Known diabetes and having uncontrolled sugar levels

Known hypertensive with a systolic blood pressure of more than equal to 140 mmHg

Ischemic heart disease

History of long-term usage of the oral pain killers for more than one month

Blood loss of more than one blood volume within 24 hours around 70ml/kg,

Excess continuous blood collection into the drains 7

 Intervensi
Sejarah Pemeriksaan Temuan ultrasonografi
Biopsi
rinci klinis atau mamografi

Karsinoma

MRM

Grup B (pasien yang Kelompok C (kontrol)

menerima bupivakain) tidak ada penyulingan
40 ml injeksi bupivakain 0,25%, 20 ml
melalui setiap saluran aksila dan dinding 8

dada
 Intervensi
Semua
500 ml preload
Skala analog visual pemantauan
laktat Ringer
standar

Daerah aksila Setelah menyelesaikan

Propofol injeksi
prosedur pembedahan,
(2mg/kg), dan fentanil
dua saluran air
Dinding dada injeksi (2μg/kg)
ditempatkan

Saluran pembuangan Neostigmin dan glikopirrolat

tetap tidak berfungsi di digunakan untuk membalikkan
Grup B anestesi 9
 Intervensi
Durasi analgesia dihitung dari kedatangan pasien
Pos-ekstubasipasien
di ruang pemulihan sampai VAS >3

Pain score was calculated by a trained resident for 24 hours

All the general anesthesia was given by the same consultant

All MRMs were performed by the same surgeon and team to eliminate biases

All confounding variables were controlled through exclusion criteria

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 Analisis statistik

• Age, duration of surgery, and postoperative duration of analgesia

were presented by mean±SD and range.
Numerical
• An independent sample t-test was applied for comparison of the
variables
mean span of analgesia between both the groups taking a p value
≤0.05 as statistically significant.

• American Society of Anesthesiologists (ASA) class, was presented as

The frequency and percentage.
categorica • Data was stratified for age, duration of surgery, and ASA class.
l variable • Post-stratification T-test was applied, taking a p value of ≤0.05 as
statistically significant.
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 Distribusi Umur
Menurut Kelompok
Di antara Ukuran
Sampel 60
Sebanyak 60 wanita yang
menjalani MRM secara
acak dibagi menjadi dua
kelompok. Distribusi umur
rata-rata adalah
52,48±4,76 tahun.

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 American Society of
Anesthesiologists
(ASA) Status 60
Pasien Antara Grup B
dan Grup C
ASA-I diamati pada 33 (55%)
pasien, dan ASA-II pada 27
(45%)

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Perbandingan durasi rata-rata analgesia antara kelompok pada pasien yang
menjalani MRM bertingkat dengan usia, ASA Kelas I dan II, dan durasi
pembedahan

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 Representasi Grafik
Perbandingan Rata-Rata
Durasi Analgesia Antar
Kelompok pada Pasien yang
Menjalani Mastektomi
Radikal Modifikasi
Tes ini menunjukkan bahwa ada
perbedaan yang mencolok dalam
durasi analgesia antara Grup B dan
Grup C dengan nilai p di bawah
0,005.
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 Diskusi

Kami menemukan bahwa periode waktu rata-rata pereda nyeri

jauh lebih tinggi di Grup B jika dibandingkan dengan Grup C
(10,93±1,84 jam vs 5,03±1,35)

Chhatrapat • The duration of analgesia found to be much

i et al., longer in their bupivacaine group with a p-
2019 value of <0.0001

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 Skor VAS

• A marked decrease in VAS in the first 24 hours

Alhussini
postoperatively in the bupivacaine group. Subsequently,
et al., 2019 the use of the analgesic drug was also reduced

Chhatrapat • VAS in the postoperative period at one hour, 10 hours,

i et al., and 12 hours and was found to show
2019 good pain relief in the bupivacaine group

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 Ropivakain

Wang • A similar technique of infiltrating ropivacaine 4

et al. • Patients with ropivacaine intervention showed a significant reduction in
pain was improved quality of life
2021

Patel et • The indifference of the ropivacaine group and control of total tramadol
consumption (P < 0.0001) with the duration of analgesia (P < 0.0001)
al., • They studied VAS at six hours, 12 hours, and 24 hours after MRM and it
2018 was remarkably higher in the control group compared to bupivacaine.

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 Keterbatasan Studi

The occurrence of seroma and hematoma formation in the surgical wound

Postoperative hemodynamic monitoring, infection in the wound

Patient body mass index

Only compared with control and not any other local anesthetic drug

The duration of analgesia could be further prolonged

There was no record of chronic pain on follow-up after discharge

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 Kesimpulan
Diseksi kelenjar getah bening
aksila dengan injeksi
bupivakain melalui drainase
bedah setelah MRM

Mengurangi kebutuhan
Sembuh dengan cepat
akan persyaratan Pereda nyeri
pasca operasi tanpa perlu
pembunuh rasa sakit oral pasca operasi
obat mahal
dan intravena
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 PICO
Female patients aged between 45 to 60 years with The American Society of
Patient Anesthesiologists (ASA) physical status classification system I or II,
undergoing unilateral MRM with axillary lymph node dissection

Intervention 40 ml of injection bupivacaine 0.25%, 20 ml through each axillary and chest

wall drain

Comparation
No instillation (control)

Outcome
Duration of analgesia and visual analog pain score chart
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 MELALUI
Validity
• This was a randomized controlled trial (RCT) study with a probability random sampling technique.
• All the general anesthesia was given by the same consultant. All MRMs were performed by the same surgeon and team
to eliminate biases, and all confounding variables were controlled through exclusion criteria.

Importance
• Duration of analgesia showed strong evidence of a difference in the mean when compared with groups B and C (t =
14.17, df = 58, p-value = 0.000).
• There is a marked difference in the duration of analgesia within Group B and Group C with a p-value below 0.005

Applicability
• Instillation of the wound with injection bupivacaine via surgical drains after MRM with axillary lymph node dissection
offers better postoperative pain relief and decreases the need for oral and intravenous pain killer requirements.
• Perform well after surgery and recover rapidly postoperatively without the need for costly drugs.
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TERIMA
KASIH