Abstrak
Latar Belakang: PONV masih merupakan salah satu komplikasi tersering yang terjadi setelah pembiusan, terutama pada operasi risiko tinggi PONV, seperti operasi telinga tengah. Gabapentin merupakan salah satu obat anti emetik jenis baru, yang akan dianalisa perbedaan efektivitas pencegahan PONV dan nyeri pascaoperasinya dengan obat lainnya yaitu deksametason.
Tujuan: Menganalisa adanya perbedaan efektivitas gabapentin dengan deksametason dalam mencegah PONV dan juga nyeri pascaoperasi telinga tengah.
Metode: Penelitian ini merupakan Double Blind Randomized Control Trial pada 30 pasien ASA I dan II yang sudah memenuhi kriteria inklusi dan akan menjalani operasi telinga tengah dengan anestesi umum di RSUD dr Moewardi Surakarta. Kelompok sampel terbagi dalam 3 kelompok, yaitu kelompok deksametason (diberikan deksametason 5 mg IV saat induksi), kelompok gabapentin (diberikan gabapentin 300 mg peroral 2 jam sebelum induksi) dan kelompok deksametason gabapentin (diberikan deksametason 5 mg IV saat induksi dan gabapentin 300 mg peroral 2 jam sebelum induksi). Pencatatan meliputi skala PONV (0-3) dan skala nyeri pascaoperasi menggunakan NRS (0-10), dan dinilai pada jam ke 1, ke 12, dan ke 24 pascaoperasi. Data hemodinamik, efek samping dan kejadian selama operasi diawasi dan ditangani sesuai prosedur.
Hasil: Kedua kelompok memiliki karakteristik dasar yang homogen, kecuali pada usia dimana pada uji Anova didapatkan nilai p= 0.033. Uji Kruskal walis untuk skala PONV pada jam ke 1, ke 12, dan ke 24, didapatkan nilai p= >0.05. Uji Kruskal walis untuk skala nyeri pada jam ke 1 didapatkan nilai p = 0.021. Sedangkan pada jam ke 12 dan ke 24 didapatkan nilai p= >0.05.
Kesimpulan: Gabapentin dan deksametason tidak memiliki perbedaan efektivitas yang signifikan terhadap angka kejadian PONV pascaoperasi telinga tengah. Hasil yang lebih baik didapatkan apabila kedua obat tersebut dikombinasikan. Pada pencegahan nyeri pascaoperasi, gabapentin menunjukkan hasil yang lebih baik hanya pada jam pertama.
Kata Kunci : deksametason, gabapentin, PONV, operasi telinga tengah.
Abstract
Background: PONV is still one of the most common complication after anesthsesia, especially after PONV-high risk surgery, for example middle ear surgery.
Objective: To analyze the difference in effectiveness of gabapentine and dexamethasone on the prevention of PONV and also postoperative pain after middle ear surgery.
Methods: This study was a double blind randomized controlled trial in 30 samples that had met the inclusion criteria and were carried out in the central surgical installation room of the Dr.Moewardi Hospital Surakarta. Samples were divided into three groups. First group was received 5mg of dexamethasone IV just before induction. Second group was received 300mg of gabapentine PO 2 hours before induction. And the third group was received 5mg of dexamethasone IV just before induction and 300mg of gabapentine PO 2 hours before induction. The measurements include PONV scale (0-3) and postoperative pain scale using NRS (0-10), and were recorded at the 1st hour, 12th hour, and 24th hour after surgery. The haemodynamic, side effect, and incidence during the measurement, were supervised and handled according to procedure.
Results: Both groups have basic homogenous characteristics, except for the age, where p values were obtained 0.033 in the Anova test. The Kruskal Walis test for PONV at the 1st hour, 12th hour, and 24th hour, were obtained >0.05 for p values. The Kruskal Walis test for postoperative pain at the 1st hour were obtained 0.021 for p values, but at the 12th and 24th hour, were obtained >0.05 for p values.
Conclusion: Gabapentine and dexamethasone have no significant difference in the effectiveness on the incidence rate of PONV. Better results were achieved when both drugs were combined. The effectiveness on the prevention of postoperative pain, gabapentin showed better result only at the 1st hour.
Keywords: dexamethasone, gabapentin, PONV, middle ear surgery.
