dr. nur surya - aps in makassar
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ACUTE PAIN SERVICES IN MAKASSAR
Nur Surya Wirawan
Department of Anesthesiology, Intensive Care and Pain Management Faculty of Medicine, Hasanuddin University
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The Chance for Anaesthesiology“The Departments of Anaesthesiology now have a golden opportunity to expand their services into a field where we easily can get many satisfied customers, something very different from the operating room or the intensive care unit, where our patients are asleep or too sick to appreciate our efforts.”
(Breivik. Pain Digest 1993;3:27)
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PERATURAN MENTERI KESEHATAN REPUBLIK INDONESIANOMOR 519/MENKES/PER/III/2011
TENTANGPEDOMAN PENYELENGGARAAN PELAYANAN ANESTESIOLOGI DAN
TERAPI INTENSIF DI RUMAH SAKIT
Menanggulangi masalah nyeri akut di rumah sakit (nyeri akibat pembedahan, trauma, maupun nyeri persalinan).
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BRIAN READY; ESTABLISHED THE FIRST ACUTE PAIN SERVICE IN 1988 IN SEATTLE, US
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HISTORY OF APSBefore introduction of APS (1988); traditional postoperative pain was managed by surgeon (surgeon-based)
Intramuscularly (IM), usually opioid
Prescribed by the surgeon Administered by the nurses Given prn (as required)
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SOME REASONS CITED FOR POOR ANALGESIA Common idea that pain is merely a symptom and not
harmful in itself. Mistaken impression that analgesia makes inaccurate
diagnosis. Fear of potential addiction to opioids and respiratory
depression Lack of appreciation of variability in analgesic response
to opioids. Misinterpretation of doctor’s orders by nursing staff. Patient’s difficulties in communicating their need for
analgesia.
Australian National Health and Medical Center. Acute pain management: scientific evidence (1999)
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OUR EXPERIENCE INWAHIDIN HOSPITAL HASANUDDIN UNIVERSITYACUTE PAIN SERVICE
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PELAYANAN NYERI AKUT (APS)
Tujuan APS RSWS
Memberikan Analgesia pasca bedah Aplikasi dan pengembangan teknik
analgesia yang baru Pelatihan bagi dokter dan perawat dalam
penanganan nyeri Sebagai lahan penelitian dan
pengembangan keilmuan
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There are Two Kinds of Organization Structure of APS 1. Anesthesiology-Based
APSIntroduced by B. Ready in US, 1988
2. Nurse-Based APSIntroduced by N. Rawal in Sweden,
1991
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ACUTE PAIN SERVICE FKUH-RSWS MAKASSAR
Provide management analgesia postoperative Mainly, EPIDURAL ANALGESIA Regular assessment and record Resident based APS Anesthesiologist Supervised Panduan Pelayanan Nyeri Pasca Bedah FKUH-
RSWS
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APS MODALITIES IN WAHIDIN1. Combination of NSAID + opioid
For patients without epidural catheter Intermittent NSAID IV Continuous opioid IV (drip / syringe pump)
2. Combination of LA+ opioid For patients with epidural catheter Intermittent OR with syringe pump
PCA
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Continuous epidural
Bupivacaine 0,0625% -0,1 % + Fentanyl 25µg
4 - 8 ml / jam
Intermittent epidural Dosis Interval (ml) (jam)
Bupivacaine 0,125% + Fentanyl 2µg/ml
6-10 6
EPIDURAL MODALITIES
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RECORDING IN WARD AND HCU
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F, 32 yr. Haemorrhoidectomy , 5 days after SC, with cont epidural analgesia
Male, 70 y.o. Fracture Femur, with continuous epidural analgesia
Male, 52 y.o. Post laparatomy, with Patient Controlled Epidural Analgesia Anesthesiologist-supervised APS
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DIAGRAM KASUS SESUAI PEMBEDAHANN=2823,2004-2009
Digesti
fObg
yn
Ortope
di
Urolog
i
Thora
xtum
or
Plasti
k 0.00
10.00
20.00
30.00
40.0030.77 29.53
13.40
22.08
2.48 0.74 0.99
%
%
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ACUTE PAIN SERVICE FKUH-RSWS MAKASSAR( 2010 – 2011)
Bagian n %Digestif 234 28,8Obgyn 202 24,8
Ortopedi 185 22,7Urologi 140 17,2
Dll ( Thorax, Oncology, plastik dan pediatrik 51 6,2
Total 812 100
TABEL KASUS APS SESUAI PEMBEDAHAN TAHUN 2010, N=812
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DIAGRAM KASUS APS SESUAI PEMBEDAHAN TAHUN 2010, N=812
Orthop
aedi
ObsGyn
Oncolog
y
Digestive
Urolog
y
Thora
x-vasc
ularPla
stic
Pediat
rics
0
20
40
60
80
100
120
140
160
IntermittentContinuous
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ACUTE PAIN SERVICE FKUH-RSWS MAKASSAR( 2010 – 2011)
Bagian n %Digestif 291 28,9Obgyn 270 26,8
Ortopedi 236 23,5Urologi 156 15,5
Dll ( Thorax, Oncology, plastik dan pediatrik 51 5,0
Total 1004 100
TABEL KASUS APS SESUAI PEMBEDAHAN TAHUN 2011, N=1004
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ACUTE PAIN SERVICE FKUH-RSWS MAKASSAR( 2010 – 2011)
DIAGRAM KASUS APS SESUAI PEMBEDAHAN
TAHUN 2011, N=1004
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VAS SCORE IN FIRST DAY (2011)
Before (8 hrs)
After (8 hrs)
Before (16 hrs)
After (16 hrs)
Before (24 hrs)
After (24 hrs)
0
10
20
30
40
50
60
70
80
90
65
78
70
80 80
88
1310 12 12 10
7
05
105 5 5
85
0 0 0 0
6
03 3 5
00 0 0 0 0 0
62 0 0 0 00 0
50 0 02 0 0 0 0 00 0 0 0 0 0
VAS 1 VAS 2 VAS 3 VAS 4 VAS 5 VAS 6 VAS 7 VAS 8 VAS 9 VAS 10
%
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VAS SCORE IN SECOND DAY
0
10
20
30
40
50
60
70
80
90
100
86
98
88
98 96100
50
12
2 40
4 2 0 0 0 00 0 0 0 0 05
0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 0
VAS 1 VAS 2 VAS 3 VAS 4 VAS 5 VAS 6 VAS 7 VAS 8 VAS 9 VAS 10
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SATISFACTION RATE
2%8%
65%
23%2%
Satisfaction Rate
UnsatisfiedLess SatisfiedSatisfiedVery SatisfiedGreatful
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NURSE TRAINING FOR PAIN MANAGEMENT
“ make pain visible “
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CHANGING TO NURSE BASED APS
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CONCLUSION The key to successful and safe postoperative
pain management is not so much the use of new, sophisticated and expensive techniques, but organizational structure, good protocol and excellent training of the staff is the key point
S. Schug
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GUIDELINES AND PROTOCOL Side effect and the management Troubleshooting for inadequate analgesia
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