Aim: This study aimed to compare the outcome of multimodal analgesia using transversus abdominis plane block combined with ketorolac and multimodal analgesia oral paracetamol combined with ketorolac in postoperative pain after cesarean section. Background: Post-caesarean section pain resulted in prolonged recovery time, inhibited early breastfeeding initiation, and prolonged hospitalization. Multimodal analgesia is an important component of post-cesarean section pain management but has not been established in many Indonesian hospitals. Methods: This study was a retrospective, observational analytic study on 46 patients who received low-dose sub-arachnoid block anesthesia. A total of 24 subjects received bilateral transversus abdominis plane block employing ultrasonography-guided lateral approach, with Ropivacaine 0.25% in a total volume of 30cc combined with intravenous ketorolac 30 mg/8 h (Group B). A total of 22 subjects received oral paracetamol 500 mg/6 h combined with intravenous ketorolac 30 mg/8 h (Group A). Numeric Rating Scale (NRS), length of hospitalization, and mobilization time were analyzed using the T-test at a significance level of p<0.05 (confidence interval of 95%). Results: The NRS and mean time to start mobilization of patients who received transversus abdominis plane block combined with ketorolac were significantly better than patients who received paracetamol combined with ketorolac (p<0.05). There was no significant difference in the length of hospitalization between the two techniques (p>0.05). Both modalities resulted in improvement in pain intensity over the mild pain range. Conclusion: Multimodal analgesia transversus abdominis plane block combined with ketorolac is superior to paracetamol combined with ketorolac for postoperative pain management after cesarean section.
ABSTRAKPulang paksa merupakan salah satu indikator kurangnya mutu pelayanan kesehatan karena dapat mempengaruhi kesembuhan, dan biaya. Penelitian ini bertujuan untuk mengetahui faktor-faktor penyebab kejadian pulang paksa di ruang Dahlia II RSUD Ngudi Waluyo Wlingi Kabupaten Blitar. Penelitian dilakukan dengan metode survei pada 30 responden. Instrumen penelitian menggunakan kuesioner dengan pertanyaan terbuka dan tertutup. Hasil penelitian menunjukkan 46,67% pasien setuju bahwa persepsi sehat-sakit menjadi alasan utama kejadian pulang paksa dan bukan mutu maupun keterjangkauan biaya.Kata Kunci: Kejadian pulang paksa, persepsi sehat-sakit, rawat inap ABSTRACT Discharge against medical advice is one indicator of lack of health care quality because it can affect the recovery and costs. This research is aimed to identify the factors that cause discharge against medical advice at Dahlia II ward of RSUD Ngudi
Latar belakang: Pasien pasca seksio sesarea dapat mengalami nyeri postoperatif dengan rerata skor nyeri 4,7 (skala 10). Komplikasi nyeri postoperatif pada pasien dengan komorbid kardiak dapat mengakibatkan disfungsi organ kardiopulmoner. Transversus abdominis plane block (TAP blok) sebagai blok saraf perifer memberikan analgesia pada dinding abdomen anterior. Studi kasus ini bertujuan untuk mengetahui skala nyeri post operatif, waktu mobilisasi dan lama hari rawat inap serta komplikasi kardiak post operatif pada pasien seksio sesarea dengan komorbid kardiak stenosis mitral berat yang diberikan TAP blok sebagai bagian multimodal analgesia Kasus: Pasien perempuan 31 tahun, kehamilan ke 2, usia kehamilan 34-36 minggu dengan Pre eklampsia berat, stenosis mitral berat, regurgitasi mitral ringan, regurgitasi trikuspid sedang,regurgitasi pulmonal ringan, ejection fraction (EF) 79,11%, hipertensi pulmonal high probability, Gagal jantung stadium B fungsional II. Menjalani tindakan seksio sesarea, dengan regional anestesi Sub Arachnoid Block. Setelah operasi dilakukan TAP blok bilateral dipandu ultrasound dengan regimen Ropivacaine 0,25% total volume 30 cc. Monitoring hemodinamik post operatif dilakukan di ruang rawat intensif. Pasien diamati skala nyeri selama dirawat, waktu mobilisasi dan lama hari rawat inap. Dari hasil pengamatan didapatkan hemodinamik stabil, skala nyeri 0-1 selama di rawat tanpa tambahan analgesia opioid, mobilisasi aktif dimulai hari ke 2, dan lama rawat inap selama 4 hari. Kesimpulan: TAP Blok sebagai bagian dari multimodal analgesia memberikan analgesia yang aman dan efektif pada pasien seksio sesarea dengan komorbid kardiak stenosis mitral berat, mencegah komplikasi kardiak, menurunkan penggunaan opioid, mempercepat waktu mobilisasi dan hari rawat inap sama dengan pasien normal.
Aim: This study aimed to compare the outcome of multimodal analgesia using transversus abdominis plane block combined with ketorolac and multimodal analgesia oral paracetamol combined with ketorolac in postoperative pain after cesarean section. Background: Post-caesarean section pain resulted in prolonged recovery time, inhibited early breastfeeding initiation, and prolonged hospitalization. Multimodal analgesia is an important component of post-cesarean section pain management but has not been established in many Indonesian hospitals. Methods: This study was a retrospective, observational analytic study on 46 patients who received low-dose sub-arachnoid block anesthesia. A total of 24 subjects received bilateral transversus abdominis plane block employing ultrasonography-guided lateral approach, with Ropivacaine 0.25% in a total volume of 30cc combined with intravenous ketorolac 30 mg/8 h (Group B). A total of 22 subjects received oral paracetamol 500 mg/6 h combined with intravenous ketorolac 30 mg/8 h (Group A). Numeric Rating Scale (NRS), length of hospitalization, and mobilization time were analyzed using the T-test at a significance level of p<0.05 (confidence interval of 95%). Results: The NRS and mean time to start mobilization of patients who received transversus abdominis plane block combined with ketorolac were significantly better than patients who received paracetamol combined with ketorolac (p<0.05). There was no significant difference in the length of hospitalization between the two techniques (p>0.05). Both modalities resulted in improvement in pain intensity over the mild pain range. Conclusion: Multimodal analgesia transversus abdominis plane block combined with ketorolac is superior to paracetamol combined with ketorolac for postoperative pain management after cesarean section.
Aim: This study aimed to compare the outcome of multimodal analgesia using transversus abdominis plane block combined with ketorolac and multimodal analgesia oral paracetamol combined with ketorolac in postoperative pain after cesarean section. Background: Post-caesarean section pain resulted in prolonged recovery time, inhibited early breastfeeding initiation, and prolonged hospitalization. Multimodal analgesia is an important component of post-cesarean section pain management but has not been established in many Indonesian hospitals. Methods: This study was a retrospective, observational analytic study on 46 patients who received low-dose sub-arachnoid block anesthesia. A total of 24 subjects received bilateral transversus abdominis plane block employing ultrasonography-guided lateral approach, with Ropivacaine 0.25% in a total volume of 30cc combined with intravenous ketorolac 30 mg/8 h (Group B). A total of 22 subjects received oral paracetamol 500 mg/6 h combined with intravenous ketorolac 30 mg/8 h (Group A). Numeric Rating Scale (NRS), length of hospitalization, and mobilization time were analyzed using the T-test at a significance level of p<0.05 (confidence interval of 95%). Results: The NRS and mean time to start mobilization of patients who received transversus abdominis plane block combined with ketorolac were significantly better than patients who received paracetamol combined with ketorolac (p<0.05). There was no significant difference in the length of hospitalization between the two techniques (p>0.05). Both modalities resulted in improvement in pain intensity over the mild pain range. Conclusion: Multimodal analgesia transversus abdominis plane block combined with ketorolac is superior to paracetamol combined with ketorolac for postoperative pain management after cesarean section.
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