the efficacy of intravenous paracetamol versus tramadol for postoperative analgesia after ...
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8/16/2019 The efficacy of intravenous paracetamol versus tramadol for postoperative analgesia after adenotonsillectomy in …
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Jour nal of Clinical Anesthesia (2011) 23, 53 –57
Or iginal contr i bution
The eff icacy of intr aenous !ar aceta"ol er sus tr a"a#ol
f or !osto !er atie analgesia af ter a#enotonsillecto"y
in chil#r en
$ale %ar & an 'ysal () (* !ecialist in Anesthesiology)⁎, *una A& in Ta& "a+ () (* !ecialist in Anesthesiology), ,er #a %a"an () (- esi#ent in Anesthesiology),./lent .altaci () (* !ecialist in Anesthesiology),
$/lya .aşar () (Associate 0r of essor an# $ea# of )e !ar t"ent)
Anesthesiology an# - eani"ation Clinic, The (inistr y of $ealth, An& ar a Tr aining an# - esear ch $os !ital, An& ar a, Tur & ey
- eceie# 2 *e !te" ber 200 reise# 1 ay 2010 acce !te# 3 July 2010
4 ey5or #s6 A#ennotonsillecto"y
Chil#ren
araceta"ol
osto!er atie analgesia
Tr a"a#ol
A bstr act
*tu#y O b ectie6 To ealuate the eff icacy an# the 8uality of r ecoer y ith intr aenous (9:) !ar aceta"ol
er sus tr a"a#ol f or !osto!er atie analgesia af ter a#enotonsillecto"y in chil#r en;
)esign6 r os !ectie, r an#o"i+e#, #ouble< blin#e# clinical tr ial;
*etting6 O !erating r oo" an# ostanesthesia Care 'nit (AC') of a uniersity<affiliate# hos !ital;
0atients6 = A*A !hysical status 9 an# 99 chil#ren, age# = to 1= year s, sche#ule# f or a#enotonsillecto"y; 9nter entions6 All !atients er e !r e"e#icate# ith or al "i#a+ola" 0;5 "g>&g 30
"inutes bef or e sur ger y; atients er e r an#o"i+e# to to gr ou!s f olloing in#uction of gener al
anesthesia; The !araceta"ol gr ou! (n ? 32) receie# 15 "g>&g of 9: !araceta"ol an# the tra"a#ol
gr ou! (n ? 32) receie# 1;0 "g>&g of 9: tra"a#ol;
(easur e"ents6 o#ifie# $annallah !ain scor es, e"er gence agitation, Al#r ete scor es, se#ation scor es,
ti"e
to fir st a#"inistr ation of analgesic, heart r ate, an# "ean arterial bloo#!r essur e er e r ecor #e# f or each !atien
t; ata er e r ecor #e# eer y 5 "inutes f or the fir st 30 "inutes an# eer y 10 "inutes f or the r e"aining
30 "inutes in the AC', then at 2, 3, , 5, =, @, 12, an# 2 hour s in the ar #; The fr e8uency of
!osto!er atie nausea an# o"iting also as note#; *atisf action of !ar ents an# nur ses as #eter "ine# on
a < !oint scale at the en# of the stu#y;
(ain - esults6 o significant #e"ogr a !hic #iff er ences beteen gr ou!s er e note#; o
statistically
significant #ifferenceasf oun# in !osto!eratie !ain scoresin either gr ou!; Agitation scores, Al#rete scores, se#ation scores, an# nu" ber of !atients ho receie# rescue analgesia an# ti"e to a#"inistration of
r escue analgesia er e si"ilar in both gr ou!s;
Conclusions6 The 9: f or "ulation of !ar aceta"ol as associate# ith si"ilar analgesic !r o!er ties an#
ear ly r ecoer y to that of 9: tr a"a#ol af ter a#enotonsillecto"y in chil#r en;
B 2011 lseier 9nc; All r ights r eser e#;
⁎ Corres !on#ing author ; D; "eE .ul;, C; AtFf 4 ansu Ca#;, 11;*o&;, @>7 .algat, An& ara, Tur & ey;
<"ail a##r ess6 haleuysalGg"ail;co" ($;%; 'ysal);
052<@1@0>H – see fr ont "atter B 2011 lseier 9nc; All rights reser e#;
#oi610;101=>; clinane;2010;07;001
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5
1; 9ntr o#uction
A#enotonsillecto"y is a co""on sur gical !r oce#ur e in
chil#r en; onster oi#al anti<infla""ator y #r ugs ( *A9s)
ar e eff ectie in r e#ucing !osto!er atie !ain, ith a loer ris&
of !osto!er atie nausea an# o"iting (O:); $oeer ,
they also intr o#uce the !ossi bility of incr ease# blee#ing #ue
to their anti !latelet eff ect I1,2; O!ioi#s !r oi#e satisf actor y
analgesia an# better e"er gence in chil#r en un#er going ear ,
nose, an# thr oat ( T) sur ger y, but !r olonge# se#ation #ue
to o!ioi# use is one of the r easons f or #elaye# #ischar ge
fr o" the hos !ital after #ay<case sur geries I3; The
efficacy of tr a"a#ol in r elieing !ost<tonsillecto"y !ain
has been ell #ocu"ente# I,5; ue to its negligi ble eff ect
on r es !ir ation, tr a"a#ol "ay be !r ef er a ble to tr a#itional
o!ioi#s, but si#e eff ects such as O: occur I2;
ar aceta"ol is a non<o!ioi# analgesic that is #eoi# of
these ris& s; 9ts analgesic action is assu"e# to be "e#iate# by
a ser otoner gic "echanis", an# the anti !yr etic action is ia
inhi bition of cyclooKygenase<3 in the hy!othala"us I=;ar aceta"ol also has little anti !latelet actiity an# #oes not
aff ect blee#ing ti"e, unli& e *A9s I7; Although enter al
f or "ulations of !ar aceta"ol ar e the "ost co""only use#
analgesics f or "anage"ent of !ain in chil#r en, their
analgesic efficacy is ea& after T sur ger y I@,; An
intr aenous (9:) f or "ulation of !ar aceta"ol r ecently has
beco"e aaila ble, an# it achiees tar get !las"a concentr a<
tion "or e r a !i#ly ith r e#uce# aria bility co" !ar e# ith the
r ectal an# or al f or "ulations I10,11;
This r an#o"i+e#, #ouble< blin#, clinical stu#y as
un#erta& en to ealuate the eff ectieness of 9: !ar aceta"ol
on !osto!er atie !ain an# its eff ect on the 8uality of r ecoer y
er sus 9: tr a"a#ol in chil#r en after a#enotonsillecto"y;
Co" !arison of the fr e8uency of O: an# satisf action of
the nur ses an# !ar ents ith the stu#y #r ugs er e secon#ar y
ob ecties of the stu#y;
2; (ater ials an# "etho#s
The stu#y !r otocol as a !!r oe# by the 9nstitutional
thics Co""itee of An& ar a Tr aining an# - esear ch $os !ital;
Lritten, inf or "e# consent er e obtaine# fr o" the !ar ents
an# fr o" the chil#r en oer @ year s of age; A total of ==healthy, A*A !hysical status 9 an# 99 chil#r en, age# beteen
= an# 1= year s, an# sche#ule# f or a#enotonsillecto"y
o!er ation, er e enr olle# in the stu#y; Kclusion criteria er e
a &non histor y of aller gy to the stu#y #r ugs actie an#
seer e r enal, he !atic, r es !ir ator y, or car #iac #isease an#
neur ological or neur o"uscular #isor #er s;
Chil#r en er e f aste# fr o" soli# f oo#s f or = hour s bef or e
the !r oce#ur e clear li8ui#s er e !er "itte# until to hour s
!rior to sur ger y; All stu#y !atients er e !r e"e#icate# ith
or al "i#a+ola" 0;5 "g>&g 30 "inutes bef or e sur ger y; 9n
$;%; 'ysal et al;
the o!er ating r oo"6 electr ocar #iogr a !hy (CM), non<
inasie bloo# !r essur e, an# !ulse oKi"etr y "onitor s
er e attache#; Anesthesia as in#uce# ith 9: f entanyl
1;0 lg>&g an# 9: !r o!of ol 2;0 to 3;0 "g>&g; :ecur oniu"
br o"i#e 0;1 "g>&g as gien f or "uscle r elaKation; After
tr acheal intubation, the lungs er e "echanically entilate#
ith the !r essur e<contr olle# "o#e ( !r essur e<contr olle#
entilation at 15 c" $2O), an# en#<ti#al car bon #ioKi#e(TCO2) tension as "aintaine# at 30<35 ""$g;
9ntr aenous flui# "anage"ent inclu#e# a#"inistr ation of
lactate# - inger Ns solution; lui# #eficit as calculate# to be
r e !lace# oer thr ee hour s, an# "aintenance flui# as
calculate# accor #ing to !atientsN eights;
Anesthesia as"aintaine# ith 1;5k to2;5k seoflur ane
an# 50k nitr ous oKi#e in oKygen at a total fr esh gas flo of
2;0 >"in; o a##itional o!ioi#s er e gien intr ao!er atiely;
At the en# of the o!er ation, r esi#ual neur o"uscular bloc& as
r eer se# ith neostig"ine 0;0 "g>&g an# atr o!ine 0;02 "g>
&g, an# the en#otr acheal tube as r e"oe# hen r es !ir ation
as r egular an# a#e8uate in r ate an# #e !th; $eart r ate ($- ),
systolic (*.) an# #iastolic (.) arterial bloo# !r essur es,
oKygen satur ation (*!O2), an# TCO2 er e "onitor e#
continuously #uring the !r oce#ur e;
After in#uction of anesthesia an# bef or e the sur gical
incision, the chil#r en er e r an#o"i+e# to one of the to
gr ou!s using a co" !uter<gener ate# r an#o" nu" ber s ta ble,
ith 33 !atients in each gr ou!; atients in the !ar aceta"ol
gr ou! r eceie# 15 "g>&g of 9: !ar aceta"ol (erf algan) an#
the tr a"a#ol gr ou! !atients r eceie# 1;0 "g>&g of 9:
tr a"a#ol (Tr a"a#olor ) oer 15 "inutes; The "e#ications
er e #ilute# ith saline to a total olu"e of 75 "; All
stu#y #r ugs er e !r e !ar e# by an anesthesiologist ho as
blin#e# to the #etails of the stu#y;After !atient arrial at the AC', !osto!er atie obser a<
tional !ain scor es, e"er gence agitation, Al#r ete scor es I12,
$-, an# "ean arterial bloo# !r essur e (A) er e r ecor #e#
eer y 5 "inutes #uring the fir st 30 "inutes, then eer y 10
"inutes f or the r e"aining 30 "inutes of the AC' stay;
atients er e then tr ansf err e# to the ar #; At the ar #,
obser ational !ain scor es, $-, an# A er e r ecor #e# at 2,
3, , 5, =, @, 12, an# 2 hour s !osto!er atiely; All
!osto!er atie obser ations an# scor es er e !erf or "e# by
the sa"e anesthesiologist ho as unaar e of the !atientsN
gr ou! assign"ent;
ain as assesse# using a "o#ification of the !ainscor e scale originally #escri be# by $annallah et al I13; This
assess<"ent alloe# f or a "aKi"u" scor e of 10 an# a
"ini"u" of 0; This scale has been ali#ate# in inf ants an#
chil#r en an# has been use# to scor e !ain after T sur ger y
I3,1; uring the fir st = hour s, !atients ith a !ain scor e of
or "or e r eceie# r escue analgesia ith 9: "e !eri#ine 0;5
"g>&g, to a total #ose of 1;0 "g>&g until the !ain scor e
as b ; Ther eafter , or al !ar aceta"ol 20 "g>&g as
a#"inister e# eer y = hour s; Any !atient ith a !ain scor e
of or "or e, in s !ite of haing r eceie# or al !ar aceta"ol,
r eceie# or al i bu!r of en 10 "g>&g;
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9: !ar aceta"ol in chil#r en !ost<tonsillecto"y 55
Table 1 atient char acter istics an# #ur ation of anesthesia er e co" !ar e# using the ann Lhitney ' test; The
an# sur ger y
:ar ia ble
Age (yrs)
Leight (&g)
Men#er
(o"en>"en) uration of
anesthesia ("in)
ur ation of
sur ger y ("in)
ar aceta"ol
gr ou! (n ? 32)
10 (=<1=)
3 (33<5@)
15>17
55;7 F 17;13
;= F 1=;@
Tr a"a#ol
gr ou! (n ? 32)
10 (=<15)
35 (33<70)
1>13
52;3 F 17;27
3;3 F 15;5
0<alue
0;551
0;3
0;31=
0;10@
0;05=
.onf err oni corr ection as a !!lie# f or all !ossi ble co" !ar<
isons; or categorical co" !arisons, Chi<s8uar e analysis or
isher Ns Kact test er e use# her e a !!r o!riate; A <alue
less than 0;05 as consi#er e# statistically significant;
3; - esults
Although == chil#r en er e enr olle# in the stu#y, one chil#
as eKclu#e# fr o" the !ar aceta"ol gr ou! because of
r e blee#ing that r e8uir e# r eo!er ation one hour after sur ger y,
ata ar e "e#ians ("ini"u"<"aKi"u") f or age an# eight, a bsolute
nu"ber s f or gen#er , an# "eans F * f or #uration of anesthesia
an# sur ger y;
The e#iatric Anesthesia "er gence eliriu" (A)
*cale #eise# by *i& ich an# er "an as use# to assess
e"er gence agitation I15; At the sa"e ti"e !oints, a#er se
eff ects such as O:, se#ation, an# r e blee#ing er e
r ecor #e#; ausea as #efine# as an un!leasant f eeling
associate# ith an inclination to o"it, an# o"iting as
#efine# as the f or cef ul e ection of gastric contents thr ough
the "outh; *e#ation as assesse# using a < !oint scale,
her e 0 ? f ully aa& e, 1 ? aa& e but #r osy, 2 ? slee !ing,
but ar ousa ble by light touch or s !eech, an# 3 ? slee !ing, not
ar ousa ble); At the en# of the stu#y, !ar ents an# ar # nur ses
er e as& e# to assess the 8uality of !osto!er atie analgesia
using the f olloing satisf action scale6 1 ? ba#, 2 ? !oor , 3 ?
goo#, ? eKcellent;
A !oer analysis base# on a !r eious article I1= shoe#
that a sa" !le si+e of 20 !atients !er gr ou! as r e8uir e# toachiee a !oer of 0k an# an a of 0;05 f or #etection of a
#iff er ence of 2 in ob ectie !ain scale (O*) scor es beteen
stu#y gr ou!s; All statistical analyses er e !erf or "e# using
*** f or Lin#os, er sion 11;5 (***, Chicago, 9, '*A);
ata ar e shon as "eans (*) an# "e#ians ("ini"u"<
"aKi"u") f or continuous aria bles an# fr e8uencies ith
!er centages f or categorical aria bles, r es !ectiely; eans
5
4
3
2
1
0
an# one chil# as eKclu#e# fr o" the tr a"a#ol gr ou! because
of early #ischar ge to ho"e; Ther ef or e, the nu" ber of !atients
enter e# into analysis as 32 in each gr ou!;
o statistical #iff er ences in age, eight, #ur ation of
sur ger y, #ur ation of anesthesia (Ta ble 1), or obser ational
!ain scoring at s !ecific ti"e inter als er e note# beteen
the to gr ou!s (ig; 1);
Ther e er e also no significant #iff er ences beteen
gr ou!s in the nu" ber of !atients ho r eceie# r escueanalgesia; 9ntr aenous "e !eri#ine as gien to 10
(31;25k) !ar aceta"ol gr ou! !atients an# to (2@;1k)
tr a"a#ol gr ou! !atients ( ? 0;7@) (Ta ble 2); The "ean
ti"e to a#"inistr ation of r escue "e !eri#ine analgesia as
10;5 F =;0 "inutes in the !ar aceta"ol gr ou! an# 1@; F
20;1 "inutes in the tr a"a#ol gr ou! ( ? 0;=@) (Ta ble 2);
One chil# r eceiing 9: !ar aceta"ol an# to chil#r en
r eceiing tr a"a#ol nee#e# to #oses of "e !eri#ine
!osto!er atiely ( ? 0;313); At the ar #, to chil#r en in
the !ar aceta"ol gr ou! an# none in the tr a"a#ol gr ou!
r eceie# or al i bu!r of en ( ? 0;2);
ighteen (5=;2k
) !atients in the !ar aceta"ol gr ou! ha# anAl#r ete scor e of 10 at a#"ission to the AC' co" !ar e# ith
1= (50k) in the tr a"a#ol gr ou! ( ? 0;=1=) (Ta ble 2); The
"e#ian Al#r ete scor es at AC' a#"ission er e 10 (=<10) in
the !ar aceta"ol gr ou! an# 10 (@<10) in the tr a"a#ol gr ou!
( N 0;05) (Ta ble 2); The "ean (*) ti"e to r each an Al#r ete
scor e of 10 as 10;=F 17;@ "inutes in the !ar aceta"ol gr ou!
an# 1@;1 F 22;= "inutes in the tr a"a#ol gr ou! ( ? 0;)
Time (minutes)
Paracetamol Group Tramadol Group
,ig; 1 ean obser ational !ain scor es in the to gr ou!s thr oughout the stu#y !erio#;
O b s e r v a t i o n a l P a i n S c o r e s
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5= $;%; 'ysal et al;
Table 2 - ecoer y an# analgesic r e8uir e"ents in the Table ur se satisf action scor es
stu#y gr ou!s
:ar ia ble
Al#rete score
at AC'
a#"ission
ar aceta"ol
gr ou! (n ? 32)
10 (=<10)
Tr a"a#ol
gr ou! (n ? 32)
10 (@<10)
0<alue
0;7=7
*atisfaction
scor es P
1
2
3
araceta"ol gr ou!
(n ? 32)
2 (=;3)
(2@;1)
20 (=2;5)
1 (3;1)
Tra"a#ol gr ou!
(n ? 32)
0 (0)
@ (25)
23 (71;)
1 (3;1)
0<alue
0;3@5
o; of !atients 1@ (5=;2) 1= (50;0) 0;=1=ith an Al#r ete
score of
10 at AC'
ata ar e a bsolute nu"ber s of !atients (k);
∗ 1 ? ba#, 2 ? goo#, 3 ? er y goo#, ? eKcellent;
a#"ission (k)
Ti"e to reach an 10;=2 F 17;@5 1@;12 F 22;= 0;
Al#rete score
of 10 ("in)
o; of !atients 10 (31;2) (2@;1) 0;7@
r e8uiring
r escue
analgesia (k)
Ti"e to first 10;5 F 5;@ 1@;@@ F 20;12 0;=@
rescue
analgesia ("in)
ata are "e#ians ("ini"u"<"aKi"u"), "eans F *, or a bsolute
nu"ber s of !atients (k);
AC' ? ostanesthesia Care 'nit;
(Ta ble 2); The to gr ou!s er e co" !ar a ble r egar #ing
e"er gence agitation scor es at the AC';
*e#ation scor es #i# not change significantly oer the
cour se of the assess"ent !erio# in any gr ou! ( ? 0;270); o
#iff er ences in "ean $- or A er e note# beteen the to
gr ou!s #uring the stu#y !erio# ( N 0;05);
The fr e8uency of nausea as not significantly #iff er ent
beteen the to gr ou!s (22k in the !ar aceta"ol gr ou! an#3@k in the tr a"a#ol gr ou!) ( ? 0;171); osto!er atie
o"iting occurr e# in 1k of !ar aceta"ol gr ou! !atients an#
3k of tr a"a#ol gr ou! !atients ( ? 0;157);
ar entsN an# nur sesN satisf action scor es r egar #ing the
8uality of !ain "anage"ent er e si"ilar in both gr ou!s ( ?
0;77, ? 0;3@5) (Ta ble 3 an# Ta ble );
; )iscussion
The analgesic efficacy of 9: !ar aceta"ol 15 "g>&g an#
tr a"a#ol 1;0 "g>&g in chil#r en un#er going a#enotonsillect<
o"y as ealuate#, an# no statistical #iff er ence as f oun#
beteen gr ou!s r egar #ing !osto!er atie !ain scor es, r escue
analgesic consu" !tion, or O:; Le also f aile# to sho a
significant #iff er ence in r ecoer y char acteristics beteen
the gr ou!s;
Ther e ar e conflicting r esults a bout the efficacy of 9:
!ar aceta"ol f or !osto!er atie analgesia after tonsillecto"y
in chil#r en; Accor #ing to en#eille et al, 9: !r o!ar aceta"ol
30 "g>&g r esulte# in higher !osto!er atie !ain scor es than
#i# 9: tr a"a#ol 3;0 "g>&g gien bef or e sur gical incisionI17; A#"inistr ation of high #oses of tr a"a#ol 3;0 "g>&g
"ay hae contri bute# to the !r onounce# lo !osto!er atie
!ain scor es in their stu#y; $oeer , in another stu#y,
Alhashe"i an# aghistani r e !orte# that 9: !ar aceta"ol 15
"g>&g as an efficient analgesic si"ilar to intr a"uscular
(9) "e !eri#ine 1;0 "g>&g f or chil#r en un#er going
tonsillecto"y I1@;
aluation of r ecoer y char acteristics an# r escue analge<
sic "e#ication er e the other ob ecties of our stu#y;
Alhashe"i an# aghistani f oun# earlier r ea#iness f or
r ecoer y r oo" #ischar ge in !e#iatric !atients un#er going
#ental r estor ation ith 9: !ar aceta"ol hen co" !ar e# ith 9 "e !eri#ine I1=; *i"ilarly, in the !r esent stu#y, although
statistically no #iff er ence as #etecte# in r ecoer y char acter<
istics of both #r ugs, the "ean (*) ti"e to r each an Al#r ete
scor e of 10 in the AC' as shorter in the !ar aceta"ol gr ou!
(10;= F 17;@ "in s; 1@;1 F 22;= "in in the tr a"a#ol gr ou!);
arly r ea#iness f or AC' #ischar ge as clinically, not
statistically, #iff er ent in this stu#y, suggesting that 9:
!ar aceta"ol "ay off er the a#antage of early r ecoer y an#
early #ischar ge fr o" hos !ital, hich lea#s to beneficial
econo"ic as !ects f or #ay<case sur geries in chil#r en;
es !ite the high nu" ber of !atients r eceiing r escue
analgesia, !ain scor es in both gr ou!s er e loer oer the
cour se of the assess"ent !erio# in this stu#y; The "e !eri#ine
Table 3 ar ent satisf action scor es;
*atisfaction araceta"ol gr ou! Tra"a#ol gr ou!
scores P (n ? 32) (n ? 32)
1 0 (0) 0 (0)
2 (12;5) 3 (;)
3 23 (71;) 22 (=@;@)
5 (15;=) 7 (21;)
ata are a bsolute nu" ber s of !atients (k);
∗ 1 ? ba#, 2 ? goo#, 3 ? er y goo#, ? eKcellent;
0<alue
0;77
r escue analgesia "ay hae influence# the subse8uent lo
!ain scor es in both gr ou!s; These #ata er e in #isagr ee"ent
ith the r esults of Alhashe"i an# aghistani I1@, ho
r e !orte# a high !er centage of !atients r e8uiring r escue
"or !hine analgesia in the 9: !ar aceta"ol gr ou! er sus the
"e !eri#ine gr ou!; This "ay be #ue to the f act that
"e !eri#ine as "or e eff ectie than tr a"a#ol f or !ain r elief
after tonsillecto"y in chil#r en I1;
:o"iting occurr e# in 0k to =5k of chil#r en after
tonsillecto"y #ue to salloe# bloo# an# or o!har yngeal
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9: !ar aceta"ol in chil#r en !ost<tonsillecto"y
irritation I20<22; Tr acheal intubation an# use of
o!ioi#s an# nitr ous oKi#e all hae been i"!licate#
as anesthetic f actor s incr easing the r ate of O:
I23; The a#"inistr ation of tr a"a#ol f or
!osto!er atie analgesia also "ay hae ana##itie eff ect on the inci#ence of O: I2,25;
9n our stu#y, the fr e8uency of O: as not as
high as has been state# in !r eious r e !orts; These
#ata "ay r esult in !art fr o" the anesthetic r egi"en
that e use# in both gr ou!s; Another eK!lanation
f or the #iscr e!ancy in o"iting #ata "ay be the
intr ao!er atie a#"inistr ation of tr a"a#ol as an 9:
inf usion oer 15 "inutes, hich r e#uces the
fr e8uency of O: co" !ar e# ith !osto!er atie
a#"inistr ation I5,25;
One li"itation of our stu#y as the lac& of a tr ue
!lacebo gr ou!; Le a#"inister e# intr ao!er atie
o!ioi# to all !atients in the stu#y because e
beliee# that chil#r en in a !lace bo gr ou! oul#
aa&en in !ain an# r e8uir e r escue "e!eri#ine
analgesia in the early !osto!er atie !erio#, hich
oul# hae influence# !osto!er atie !ain scor es,
agitation scor es, an# se#ation scor es;
9n conclusion, the !osto!er atie analgesia
an# early r ea#iness f or #ischar ge fr o" the
AC' !r oi#e# by 9: !ar aceta"ol 15 "g>&g as
si"ilar to the outco"e ith 9: tr a"a#ol 1;0 "g>&g
in chil#r en after a#enotonsillecto"y;
- ef er ences
I1 arret , lahault A, *a"a"a C, .onnet ; ffects of
!osto!er atie, nonster oi#al, antiinfla""ator y #r ugs on
blee#ing ris& after tonsillec<to"y6 "eta<analysis of
ran#o"i+e#, contr olle# trials; Anesthesiology
2003@617<502;
I2 un#e ber g *, Qnn8ist A; '!#ate on syste"ic
!osto!eratie analgesia in chil#ren; ae#iatr Anaesth
200163<7;
I3 :iitanen $, Annila ; Analgesic efficacy of tr a"a#ol 2 "g
&g(<1) f or !ae#iatric #ay<case a#enoi#ecto"y; .r J Anaesth
2001@=6572<5;
I Courtney J, Ca braal ; Tra"a#ol s; #iclofenac f or !osttonsillect<o"y analgesia; Arch Otolar yngol $ea# ec&
*ur g 200112763@5<@;
I5 ngelhar #t T, *teel , Johnston M, :eitch %; Tr a"a#ol f or
!ain relief in chil#ren un#er going tonsillecto"y6 a
co" !arison ith "or !hine; ae#iatr Anaesth 20031362<
52;
I= ic& ering M, oriot A, i bert , schalier A, .eaune ,
ubr ay C; Analgesic eff ect of aceta"ino!hen in hu"ans6
fir st ei#ence of a centr al ser otoner gic "echanis"; Clin
har "acol Ther 200=76371<@;
I7 Mraha" MM, *cott 4; echanis" of action of
!araceta"ol; A" J Ther 2005126=<55;
I@ :iitanen $, Tuo"inen , :RRrRnie"i $, i& anne ,
Annila ; Analgesic efficacy of r ectal aceta"ino!hen an#
i bu!r of en alone or in co"bination f or !ae#iatric #ay<casea#enoi#ecto"y; .r J Anaesth
2003163=3<7;
57
I a !!as A, lu#er , Creech *, $otaling A, ar & A;
osto!eratie analgesia in chil#ren un#er going
"yringoto"y an# !lace"ent e8uali+ation tubes in
a"bulator y sur ger y; Anesth Analg 2003=6 1=21<;
I10 Lurthein M, 4oling *, - eich A, et al;
har "aco& inetics of intr aenous !ar aceta"ol inchil#ren an# a#olescents un#er "aor sur ger y; ur J Clin
har "acol 2005=06@@3<@;
I11 An#er son .J, ons M, Autret<eca , Allegaert 4,
.occar # ; ae#iatric intraenous !araceta"ol
( !r o!aceta"ol) !har "aco& inetics6 a !o!ulation analysis;
ae#iatr Anaesth 20051562@2<2;
I12 Al#rete JA; The !ost<anesthesia recoer y score reisite#; J
Clin Anesth 1576@<1;
I13 $annallah -*, .r oa#"an , .el"an A., Abra"oit+
, !stein .*; Co"!arison of cau#al an#
ilioinguinal>iliohy!ogastric ner e bloc&s f or contr ol of
!ost<or chio!eKy !ain in !e#iatric a"bulator y sur ger y;
Anesthesiology 1@7==6@32<;
I1 As !inall - , ayor A; A !r os !ectie ran#o"i+e#
contr olle# stu#y of the efficacy of & eta"ine f or !osto!eratie !ain relief in chil#ren after
a#enotonsillecto"y; ae#iatr Anaesth 2001116333<=;
I15 *i& ich , er "an J; eelo!"ent an# !sycho"etric
ealuation of the !e#iatric anesthesia e"er gence #eliriu"
scale; Anesthesiology 200 1006113@<5;
I1= Alhashe"i JA, aghistani ; ffect of intrao!eratie
intraenous aceta"ino!hen s; intra"uscular "e !eri#ine
on !ain an# #ischar ge ti"e af ter !ae#iatr ic #ental
r estor ation; ur J Anaesthesiol 200726 12@<33;
I17 en#eille , :on ontigny *, ort J, :eyc& e"ans
; ouble< blin# ran#o"i+e# stu#y of tra"a#ol s;
!araceta"ol in analgesia after #ay<case tonsillecto"y in
chil#ren; ur J Anaesthesiol 2000176 57=<@2;
I1@ Alhashe"i JA, aghistani ; ff ects of
intr ao!er atie i;; aceta"ino!hen s i;"; "e !er i#ineon !ost<tonsillecto"y !ain in chil#ren; .r J Anaesth
200==670<5;
I1 O+er S, MQr /r 4 , Altun& an AA, .ilgin , Ca"#eiren
$, Oral '; fficacy of tra"a#ol er sus "e !eri#ine f or
!ain r elief an# saf e r ecoer y af ter a#enotonsillecto"y;
ur J Anaesthesiol 200320620<;
I20 4o&& i $, *alonen A; Co"!arison of !r e< an#
!osto!eratie a#"inistration of & eto!r ofen f or
analgesia after tonsillecto"y in chil#ren; ae#iatr
Anaesth 20021261=2<7;
I21 anar ese A, Clar & e -L, %ar #ley ; ar ly !ost<o!er atie
"or bi#ity f olloing tonsillecto"y in chil#r en6
i"!lications f or #ay sur ger y; J ar yngol Otol
1113610@<1;
I22 Ang C, $a bre L, *i"s C; Tr o!isetr on re#uces o"iting after tonsillecto"y in chil#ren; .r J Anaesth
1@@067=1<3;
I23 ah ., -obb J, - a ; osto!er atie !ain, nausea
an# o"iting f olloing !ae#iatric #ay<case tonsillecto"y;
Anaesthesia 200==16 11=<22;
I2 an #en .er g AA, $alli#ay , ule 4 , .aloch *; The
effects of tra"a#ol on !osto!eratie nausea, o"iting
an# hea#ache after T sur ger y; A !lace bo<contr olle#
co"!arison ith e8ui !otent #oses of nal bu!hine an#
!ethi#ine; Acta Anaesthesiol *can# 1 362@<33;
I25 ang LL, o& *, $uang *, $ung C, $uang $;
9ntrao!eratie loa#ing attenuates nausea an# o"iting of
tra"a#ol !atient<contr olle#
analgesia; Can J Anaesth 200076=@<73;
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fe&tiitas araseta"ol 9ntraena #iban#ing&an Tra"a#ol
untu& Analgesia asca O!erasi *etelah A#enotonsile&to"i
a#a Ana&<ana&
Hale Yarkan Uysal MD (Spesialis Anestesiologi ), Suna Akin
Takmaz MD (Spesialis Anestesiologi), Fera Yaman MD (!esient
Anestesiologi), "#lent "alta$i MD (Spesialis Anestesiologi),
H#lya "asar MD (Asso$iate %ro&essor an 'epala Departemen)
Anestesiologi #an -eani"asi 4lini&, e!arte"en 4esehatan, An&ara elatihan #an enelitian
-u"ah *a&it, An&ara, Tur&i
Abstrak
Tuuan enelitian 6 'ntu& "engealuasi efe&tiitas #an &ualitas !e"ulihan #engan intraena
(9:) !araseta"ol #iban#ing&an tra"a#ol untu& analgesia !asca o!erasi setelah
a#enotonsile&to"i !a#a ana&<ana&;
esain6 prospective, randomized , double-blinded clinical trial ;
Te"!at6 -uang O!erasi #an 'nit ost Anesthesia Care (AC') #ari sebuah ru"ah sa&it
uniersitas yang berafiliasi;
asien6 = status fisi& A*A 9 #an 99 ana&, usia = sa"!ai 1= tahun, #ia#al&an untu&
a#enotonsile&to"i;
9nterensi6 *e"ua !asien !re"e#i&asi #engan "i#a+ola" oral 0,5 "g>&g 30 "enit sebelu"o!erasi; asien #iaca& "ena#i #ua &elo"!o&, setelah in#u&si anestesi u"u"; 4elo"!o&
!araseta"ol (n ? 32) "eneri"a 15 "g > &g 9: !araseta"ol #an &elo"!o& tra"a#ol (n ? 32)
"eneri"a 1,0 "g > &g 9: tra"a#ol;
engu&uran6 o#ifi&asi $annallah s&or nyeri, "unculnya agitasi, s&or Al#rete, s&or se#asi,
a&tu untu& !e"berian analgesi& !erta"a, #enyut antung, #an rata<rata te&anan #arah arteri
#ire&a" untu& setia! !asien; ata #icatat setia! 5 "enit untu& 30 "enit !erta"a #an setia!
10 "enit untu& sisa 30 "enit #i AC', "a&a !a#a 2, 3, , 5, =, @, 12, #an 2 a" #i
ling&ungan; re&uensi "ual #an "untah !asca o!erasi uga #icatat; 4e!uasan orang tua #an
!eraat #itentu&an !a#a s&ala <titi& !a#a a&hir !enelitian;
$asil !enelelitian4esi"!ulan6 a#a!un for"ulasi 9: !araseta"ol yang berhubungan #engan sifat analgesi&
yang sa"a #an !e"ulihan aal #engan 9: tra"a#ol setelah a#enotonsile&to"i !a#a ana&<
ana&;
4ata &unci6 A#ennotonsillecto"y ana&<ana& !araseta"ol Analgesia !asca o!erasi tra"a#ol
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1. Pendahuluan
A#enotonsile&to"i a#alah !rose#ur
!e"be#ahan u"u" !a#a ana&<ana&; Obat anti<
infla"asi non steroi# (*A9) efe&tif #ala"
"engurangi nyeri !asca o!erasi, #engan
ren#ahnya risi&o "ual #an "untah !asca o!erasi
(O:); a"un, "ere&a uga "e"!unyai efe&
&e"ung&inan !ening&atan !er#arahan a&ibat
efe& anti!latelet I1,2; O!ioi# "e"beri&an
analgesia yang "e"uas&an #an "e"beri&an
hasil lebih bai& !a#a ana&<ana& yang "enalani
o!erasi telinga, hi#ung, #an tenggoro&an (T$T),
teta!i se#asi ber&e!anangan a&ibat !enggunaan
o!ioi# a#alah salah satu alasan untu& "enun#a
!ulang #ari ru"ah sa&it setelah sehari o!erasi
I3; fe&tiitas tra"a#ol #ala" "engurangi nyeri
!asca tonsile&to"i telah #i&etahui I,5; 4arenaefe&nya yang #a!at #iabai&an !a#a res!irasi,
tra"a#ol "ung&in lebih bai& untu& o!ioi#
tra#isional, teta!i "e"ili&i efe& sa"!ing se!erti
O: I2;
araseta"ol "eru!a&an analgesi& non<o!ioi#
yang ti#a& "e"ili&i resi&o; Tin#a&an analgesi&
"e"!unyai "e&anis"e &era serotonergi&, #an
tin#a&an anti!ireti&nya "elalui !engha"batan
si&loo&sigenase<3 #i hi!otala"us I=;
araseta"ol uga "e"ili&i a&tiitas anti!latelet
&ecil #an ti#a& "e"!engaruhi a&tu !er#arahan,
ti#a& se!erti *A9 I7; es&i!un for"ulasi
enteral !araseta"ol a#alah analgesi& yang !aling
u"u" #iguna&an untu& "anae"en nyeri !a#a
ana&<ana&, &hasiat analgesi& !araseta"ol le"ah
setelah o!erasi T$T I@,; *ebuah intraena (9:)
for"ulasi !araseta"ol telah terse#ia, #an itu
"enca!ai sasaran !las"a &onsentrasi<tion lebih
ce!at #engan ariabilitas ber&urang#iban#ing&an #engan for"ulasi re&tal #an oral
I10,11;
*tu#i &linis secara aca& #ouble<blin#
#ila&u&an untu& "engealuasi efe&tiitas 9:
!araseta"ol !a#a nyeri !asca o!erasi #an
efe&nya !a#a &ualitas !e"ulihan #iban#ing&an
9: tra"a#ol !a#a ana&<ana& setelah
a#enotonsile&to"i; erban#ingan fre&uensi
O: #an &e!uasan #ari !ara !eraat #an orang
tua #engan obat stu#i a#alah tuuan se&un#er
!enelitian;
2. Bahan dan metode
roto&ol !enelitian telah #isetuui oleh
4o"ite ti&a 4ele"bagaan An&ara elatihan #an
enelitian -u"ah *a⁢ itulis, infor"e#
consent #i!eroleh #ari orang tua #an ana&<ana&
lebih #ari @ tahun; *ebanya& == status fisi& yang
sehat, A*A 9 #an 99 ana&, berusia antara = #an 1=
tahun, #an #i a#al&an untu& o!erasi
tonsile&to"i orang #easa, yang ter#aftar #ala"
!enelitian ini; 4riteria e&s&lusi a#alah riayat
#i&etahui alergi terha#a! obat a&ut #an &roni&
ginal, hati, !ernafasan, atau !enya&it antung
#an gangguan neurologis atau neuro"uscular;Ana&<ana& ber!uasa #ari "a&anan !a#at
sela"a = a" sebelu" !rose#ur cairan bening
#i!erboleh&an sa"!ai #ua a" sebelu" o!erasi;
*e"ua !asien stu#i #i !re"e#i&asi #engan
"i#a+ola" oral 0,5 "g > &g 30 "enit sebelu"
o!erasi; i ruang o!erasi 6 #i !asang
ele&tro&ar#iografi (4M), te&anan #arah non<
inasif, #an !ulse oKi"etry "onitor; Anestesi
#iin#u&si #engan 9: fentanyl 1,0 lg > &g #an
!ro!ofol 9: 2,0<3,0 "g > &g; :ecuroniu"
bro"i#e 0,1 "g > &g #iberi&an untu& rela&sasi
otot; *etelah intubasi tra&ea, !aru<!aru secara
"e&anis berentilasi #engan Cara te&anan yang
#i&ontrol (te&anan entilasi<#i&ontrol !a#a 15 c"
$2O), #an en#<ti#al &arbon #io&si#a (TCO2)
te&anan #i!ertahan&an !a#a 30<35 ""$g;
anae"en cairan intraena ter"asu& !e"berian
larutan la&tat -inger; 4e&urangan cairan #ihitung
harus #iganti lebih #ari tiga a", #an cairan"aintenance #ihitung "enurut berat ba#an
!asien;
Anestesi #i!ertahan&an #engan 1;5& to 2;5&
seoflurane #an 50& nitrous oKi#e #ala" o&sigen
!a#a aliran gas segar total 2;0>"in; Ti#a& a#a
o!ioi# ta"bahan #iberi&an intrao!eratif; a#a
a&hir o!erasi, blo& neuro"us&ular resi#ual
terbali& #engan neostig"in 0,0 "g > &g #an
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atro!in 0,02 "g > &g, #an tabung en#otra&eal #i
le!as &eti&a res!irasi teratur #an "e"a#ai #ala"
lau #an &e#ala"an; enyut antung ($-),
sistoli& (*.) #an #iastoli& (.) te&anan #arah
arteri, saturasi o&sigen (*!O2), #an TCO2
#i!antau terus "enerus sela"a !rose#ur;
*etelah in#u&si anestesi #an sebelu" sayatan
be#ah, ana&<ana& secara aca& salah satu #ari #ua
&elo"!o& #engan "engguna&an tabel ang&a aca&
yang #ibuat #engan &o"!uter, #engan 33 !asien
#ala" setia! &elo"!o&; asien #ala" &elo"!o&
!araseta"ol "eneri"a 15 "g > &g 9:
!araseta"ol (erfalgan) #an !asien &elo"!o&
tra"a#ol "eneri"a 1,0 "g > &g 9: tra"a#ol
(Tra"a#olor) lebih #ari 15 "enit; Obat<obat yang
#iencer&an #engan saline untu& total olu"e 75
"; *e"ua obat !enelitian yang #isia!&an olehahli anestesi untu& rincian !enelitian;
*etelah !asien tiba #i AC', obserasi s&or
nyeri !asca o!erasi, "unculnya agitasi, s&or
Al#rete I12, $-, #an rata<rata te&anan #arah
arteri (A) #icatat setia! 5 "enit sela"a 30
"enit !erta"a, &e"u#ian setia! 10 "enit untu&
sisa 30 "enit #ari &e#atangan AC'; asien
&e"u#ian #i!in#ah&an &e bangsal; i bangsal,
s&or !enga"atan sa&it, $-, #an A tercatat
!a#a 2, 3, , 5, =, @, 12, #an 2 a" !asca
o!erasi; *e"ua !enga"atan !asca o!erasi #an
s&or #ila&u&an oleh ahli anestesi yang sa"a yang
ti#a& "enya#ari !ara !asien &elo"!o& tugas;
yeri #inilai "engguna&an "o#ifi&asi #ari
s&ala s&or nyeri aalnya #iga"bar&an oleh
$annallah et al I13; 9ni !eng&aian
#i!erboleh&an untu& s&or "a&si"u" 10 #an
"ini"u" 0; *&ala ini telah #iali#asi !a#a bayi
#an ana&<ana& #an telah #iguna&an untu& "enceta& rasa sa&it setelah o!erasi T$T I3,1;
*ela"a = a" !erta"a, !asien #engan s&or nyeri
#ari atau lebih #iberi&an analgesia #engan 9:
"e!eri#in 0,5 "g > &g, #engan #osis total 1,0
"g > &g sa"!ai s&or nyeri a#alah b ; *etelah itu,
!araseta"ol oral 20 "g > &g #iberi&an setia! =
a"; *etia! !asien #engan s&or nyeri #ari atau
lebih, "es&i!un telah "eneri"a !araseta"ol
oral, #an uga #iberi&an ibu!rofen oral 10 "g >
&g;
The e#iatric Anestesi "ergence eliriu"
(A) *cale yang #ibuat oleh *i&ich #an
er"an #iguna&an untu& "enilai "unculnyaagitasi I15; a#a titi& a&tu yang sa"a, efe&
sa"!ing se!erti O:, se#asi, #an !er#arahan
ulang #icatat; ual #i#efinisi&an sebagai
!erasaan yang ti#a& "enyenang&an ter&ait
#engan &ecen#erungan untu& "untah, #an
"untah #i#efinisi&an sebagai ee&si &uat isi
la"bung "elalui "ulut; *e#asi #inilai
"engguna&an s&ala <titi&, #i "ana 0 ?
se!enuhnya teraga, 1 ? teraga teta!i "engantu&,
2 ? "engantu&, ta!i arousable #engan sentuhan
ringan atau suara, #an 3 ? ti#ur, ti#a& arousable);
a#a a&hir !enelitian, orang tua #an !eraat
bangsal #i"inta untu& "enilai &ualitas analgesia
!ascao!erasi "engguna&an s&ala &e!uasan
beri&ut6 1 ? sangat buru&, 2 ? buru&, 3 ? bai&, ?
sangat bai&;
aya analisis ber#asar&an !a#a arti&el
sebelu"nya I1= "enunu&&an baha u&uran
sa"!el #ari 20 !asien !er &elo"!o& #i!erlu&anuntu& "enca!ai &e&uatan 04 #an #ari 0,05
untu& "en#ete&si !erbe#aan #ari 2 #i s&ala nyeri
obye&tif (O*) s&or antara &elo"!o& belaar;
*e"ua analisa statisti& #ila&u&an #engan
"engguna&an *** for Lin#os, ersi 11;5
(***, Chicago, 9, '*A); ata #ita"!il&an
sebagai sarana (*) #an "e#ian ("ini"u"<
"a&si"u") untu& ariabel &ontinyu #an
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fre&uensi #engan !ersentase untu& ariabel
&ategori, "asing<"asing; Cara itu #iban#ing&an
#engan "engguna&an ui ann Lhitney ';
&ore&si .onferroni #itera!&an untu& se"ua
!erban#ingan "ung∈ 'ntu& !erban#ingan
&ategoris, analisis Chi<s8uare atau ui Kact
isher #iguna&an bila sesuai; *ebuah <nilai
&urang #ari 0,05 #iangga! signifi&an secara
statisti&;
3. Hasil
es&i!un == ana& yang ter#aftar #ala"
!enelitian ini, satu ana& #i&eluar&an #ari
&elo"!o& !araseta"ol &arena !er#arahan ulang
"e"erlu&an reo!eration satu a" setelah o!erasi,
#an satu ana& #i&eluar&an #ari &elo"!o& tra"a#ol &arena lebih aal !ulang &e ru"ah;
Oleh &arena itu, u"lah !asien yang #i"asu&&an
&e #ala" analisis a#alah 32 #ala" setia!
&elo"!o&;
Ti#a& a#a !erbe#aan statisti& #ala" usia,
berat ba#an, #urasi o!erasi, #urasi anestesi (Tabel
1), atau s&or nyeri !enga"atan !a#a interal
a&tu tertentu yang #icatat antara &e#ua
&elo"!o& (Ma"bar 1);
Juga ti#a& a#a !erbe#aan yang signifi&an
antara &elo"!o&<&elo"!o& #ala" u"lah !asien
yang "en#a!at&an analgesi&; e!eri#in 9:
#iberi&an !a#a 10 (31;25) !asien &elo"!o&
!araseta"ol #an (2@;1) !asien &elo"!o&
tra"a#ol (!?0;7@) (Table 2);
La&tu saat aal #iberi&an analgesi&
"e!eri#in a#alah 10;5 =;0 "enit !a#a
&elo"!o& !araseta"ol #an 1@; 20;1 "enit
!a#a &elo"!o& tra"a#ol (?0;=@) (Tabel 2);
*atu ana& #iberi&an !araseta"ol 9: #an #ua ana&
yang #iberi&an tra"a#ol 9: "e"butuh&an #ua
#osis "e!eri#in !asca o!erasi (?0;313); i
bangsal, #ua ana& #ala" &elo"!o& !araseta"ol
#an ti#a& a#a !a#a &elo"!o& tra"a#ol "eneri"a
ibu!rofen oral (?0;2);
ela!an belas (5=,2) !asien #ala"
&elo"!o& !araseta"ol s&or $a#an Al#eret #ari
10 saat "asu& &e AC' #iba#ing&an #engan 1=
(50) !a#a &elo"!o& tra"a#ol ( ? 0,=1=); *&or
Al#rete "e#ian saat "asu& AC' yaitu 10 (=<10)
!a#a &elo"!o& !araseta"ol #an 10 (@<10) !a#a
&elo"!o& tra"a#ol (?0;7=7); ilai rata<rata
a&tu untu& "enca!ai s&or Al#rete #ari 10
a#alah 10;= 17,@ "enit !a#a &elo"!o&
!araseta"ol #an 1@;1 22,= "enit !a#a
&elo"!o& tra"a#ol (?0;) (Tabel 2);
4e#ua &elo"!o& seban#ing ber#asar&an s&or
"unculnya agitasi #i AC'; *&or se#asi ti#a&
berubah secara signifi&an sela"a !erio#e
!enilaian #ala" setia! &elo"!o& (?0;270);
Ti#a& a#a !erbe#aan #ala" rata<rata $- atauA yang #icatat antara &e#ua &elo"!o& sela"a
"asa !enelitian (?0;05);
re&uensi "ual ti#a& berbe#a secara
signifi&an antara &e#ua &elo"!o& (22 !a#a
&elo"!o& !araseta"ol #an 3@ !a#a &elo"!o&
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tra"a#ol) (?0;171); untah !asca o!erasi
tera#i !a#a 1 !asien &elo"!o& !araseta"ol
#an 3 !asien &elo"!o& tra"a#ol (?0;157);
*&or &e!uasan orangtua #an !eraat
"engenai &ualitas "anae"en nyeri a#alah
seru!a !a#a &e#ua &elo"!o& (?0;77, ?0;3@5)
(Tabel 3 #an Tabel );
4. Diskusi
aluasi efe&tiitas analgesi& !araseta"ol 9:
15 "g>&g #an tra"a#ol 9: 1,0 "g>&g !a#a ana&<
ana& yang "enalani a#enotonsile&to"i, #an
ti#a& a#a !erbe#aan statisti& yang #ite"u&an
antara &elo"!o& "engenai s&or nyeri
!ascao!erasi, !e"berian analgesi&, atau O:;
4a"i uga gagal untu& "enunu&&an !erbe#aan
yang signifi&an #ala" &ara&teristi& !e"ulihan
antara &elo"!o&;
Ter#a!at hasil yang ti#a& berhubungan
tentang efe&tiitas !araseta"ol 9: untu&
analgesi& !ascao!erasi setelah tonsile&to"i !a#a
ana&<ana&; enurut en#eille et al, !araseta"ol
!ro 9: 30"g>&g "enghasil&an s&or nyeri
!ascao!erasi lebih tinggi #ari tra"a#ol 9:
3,0"g>&g #iberi&an sebelu" sayatan be#ah;
e"berian #osis tinggi tra"a#ol 3,0 "g>&g
"ung&in telah "e"beri &ontribusi !a#a s&or
nyeri !ascao!erasi elas ren#ah #ala" !enelitian
"ere&a; a"un, #ala" !enelitian lain,
Alhashe"i #an aghistani "ela!or&an baha
!araseta"ol 9: 15 "g>&g a#alah analgesi& yang
efisien "iri! #engan "e!eri#in 9 1,0 "g>&g
untu& ana&<ana& yang "enalani tonsile&to"i
I1@;
aluasi &ara&teristi& !e"ulihan #an obat
!enyela"atan analgesi& a#alah tuuan lain #ari !enelitian &a"i; Alhashe"i #an aghistani
"ene"u&an &esia!an aal untu& ruang
!e"ulihan #ebit !a#a !asien ana& yang "enalani
restorasi gigi #engan 9: !araseta"ol bila
#iban#ing&an #engan 9 "e!eri#ine I1=;
e"i&ian !ula, #ala" !enelitian ini, alau!un
secara statisti& ti#a& a#a !erbe#aan ter#ete&si
#ala" !e"ulihan &ara&teristi& #ari &e#ua obat,
"ean (*) a&tu untu& "enca!ai s&or Al#rete
#ari 10 #i AC' lebih !en#e& !a#a &elo"!o&
!araseta"ol (10,= 17;@ "in s 1@,1 22;= "in
!a#a &elo"!o& tra"a#ol); 4esia!an aal untu&
AC' #ebit secara &linis, secara statisti& ti#a&,
berbe#a #ala" !enelitian ini, "enunu&&an
baha !araseta"ol 9: "ung&in "enaar&an
&euntungan #ari !e"ulihan aal #an boleh
!ulang lebih aal #ari ru"ah sa&it, yang
"engarah &e as!e& e&ono"i yang
"enguntung&an untu& o!erasi sehari<&asus !a#aana&<ana&;
es&i!un banya&nya !asien yang #iberi&an
analgeti&, s&or nyeri !a#a &e#ua &elo"!o& lebih
ren#ah sela"a !erio#e !enelitian #ala"
!enelitian ini; e"berian analgeti& "e!eri#in
"ung&in telah "e"!engaruhi ren#ahnya s&or
nyeri beri&utnya !a#a &e#ua &elo"!o&; ata ini
bertentangan #engan hasil Alhashe"i #an
aghistani, yang "en#a!at&an !ersentase tinggi !a#a !asien yang "e"butuh&an "orfin !a#a
&elo"!o& !araseta"ol 9: #engan &elo"!o&
"e!eri#in; 9ni "ung&in #isebab&an oleh fa&ta
baha "e!eri#in lebih efe&tif #ari!a#a tra"a#ol
untu& "enghilang&an rasa sa&it setelah o!erasi
a#enotonsile&to"i !a#a ana&<ana& I1;
untah tera#i !a#a 0& &e =5& ana& setelah
tonsile&to"i &arena #arah tertelan #an iritasi
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orofaringeal I20<22; 9ntubasi tra&ea #an
!enggunaan o!ioi# #an nitrous oKi#e se"ua telah
terlibat sebagai fa&tor anestesi "ening&at&an lau
O: I23; e"berian tra"a#ol untu& analgesia
!ascao!erasi uga "ung&in "e"ili&i efe& a#itif
terha#a! &ea#ian O: I2,25; ala"
!enelitian &a"i, fre&uensi O: ti#a& setinggi
se!erti yang telah #inyata&an #ala" la!oran
sebelu"nya; ata ini #a!at "enyebab&an bagian
#ari rei"en obat bius yang &ita guna&an !a#a
&e#ua &elo"!o&; enelasan lain untu&
!erbe#aan #ala" "untah #ata "ung&in
a#"inistrasi intrao!eratif tra"a#ol sebagai infus
9: sela"a 15 "enit, yang "engurangi fre&uensi
O: #iban#ing&an #engan !asca o!erasi
a#"inistrasi I5,25;
*alah satu &eterbatasan #ari !enelitian &a"ia#alah &urangnya &elo"!o& !lasebo yang benar;
4a"i "e"beri&an o!ioi# intrao!eratif untu&
se"ua !asien #ala" !enelitian ini &arena &a"i
!ercaya baha ana&<ana& #ala" &elo"!o&
!lasebo ana& terbangun &esa&itan #an
"e"butuh&an analgesi& "e!eri#in !a#a !erio#e
aal !ascao!erasi, yang a&an "e"!engaruhi
s&or nyari !ascao!erasi, s&or agitasi, #an s&or
se#asi
4esi"!ulannya, Analgesi& !ascao!erasi #an
&esia!an aal untu& &eluar #ari AC' yang
#iberi&an !araseta"ol 9: 15 "g>&g "iri! #engan
hasil tra"a#ol 9: 1,0 "g>&g !a#a ana&<ana&
setelah a#enotonsile&to"i;
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