Perbandingan antara Tramadol 100 mg dan Natrium Diklofenak 100 mg Suppositoria untuk Penanganan Nyeri Pasca Seksio Sesarea dengan Blok Subarakhnoid
Authors: Hariyadi Santoso Arief , Uyun Yusmein , Rahardjo Sri 
Published: October 2021

Latar Belakang: Seksio sesarea menyebabkan nyeri pasca operasi yang signifikan. Tidak ada standar pengelolaan nyeri pasca seksio sesarea. Obat antiinflamasi nonsteroid, natrium diklofenak berkerja meng-inhibisi sintesis prostaglandin (PG) dengan menghambat enzim cyclooxygenase. Tramadol, aktivitas mu-agonis, tidak hanya bekerja pada reseptor opioid, tetapi juga menghambat serotonin (5-HT) dan reuptake noradrenalin.Tujuan: Mengetahui daya guna analgesi 24 jam pasca seksio sesarea antara penggunaan suppositoria rektal tramadol dengan natrium diklofenakMetode:Prospektif, uji klinis acak terkontrol pada 70 pasien status fisik ASA I-II, berusia 19-40 tahun, hamil aterm 37-42 minggu. Indeks Massa Tubuh < 35 kg/m2. Pasien dibagi acak 2 kelompok: kelompok suppositoria rektal natrium diklofenak (D) dan tramadol (T) dengan teknik single blind. Dilakukan penilaian VAS pada kedua kelompok, jumlah penambahan rescue jika VAS ≥3, dan efek samping pada masing-masing kelompok.Hasil: Selama 24 jam pasca operasi, rata-rata frekuensi pemberian tambahan fentanyl kelompok T sebanyak 3,13 kali dan kelompok D 1,7 kali, rata-rata dosis tambahan fentanyl kelompok T sebanyak 155,71 mcg dan kelompok D 67,65 mcg (p=0,000). Rata-rata VAS 24 jam pasca operasi pada kelompok T 2,14 dan pada kelompok D 1,74 (p<0,05). Efek samping, kelompok T terdapat 4 kejadian (11,4%) mual muntah, pada kelompok D tidak ada. Simpulan :Daya guna analgesi natrium diklofenak 100 mg suppositoria rektal lebih baik dibanding tramadol 100 mg suppositoria rektal, dengan efek samping yang lebih kecil pada 24 jam pasca operasi sesar.

The Comparison between 100 mg Tramadol and 100 mg Diclofenac Sodium - Suppository for Handling Pain After Cesarean Section Using Subarachnoid Block
Abstract
Background: Cesarean section inflicts significant postoperative pain. There is no standard for pain management after cesarean section. Non-steroidal anti-inflammatory drugs, diclofenac sodium, work to inhibit the prostaglandin (PG) synthesis, by obstructing the cyclooxygenase enzyme. Tramadol alongside mu-agonist activity, does not only act on opioid receptors, but also inhibits serotonin (5-HT) and noradrenaline reuptake.Objective: To determine the efficacy of 24-hour postoperative cesarean section between of rectal suppositori tramadol and diclofenac sodium.Methods: Prospective, randomized controlled clinical trial to 70 patients with ASA I-II physical status, aged 19-40 years old, pregnancy aterm 37-42 weeks, Body Mass Index <35 kg / m2. The patients were randomly assigned into 2 groups: rectal diclofenac sodium suppository (D) and tramadol (T) groups using single blind technique. VAS assessment was performed in both groups. The amount of rescue was added if the VAS ≥3, and there were side effects in each group.Results: During the 24 hour postoperative period, the mean frequency of supplemental fentanyl to group T was 3.13 times, and group D was 1.7 times. The mean additional dose of fentanyl group T was 155.71 mcg, and group D was 67.65 mcg (p = 0.000 ). The average VAS was 24 hours postoperative in the T group of 2.14, and 1.74 in the D group (p <0.05). For the side effects, T group had 4 occurrences (11.4%) nausea vomiting, and zero in group D. Conclusion: The efficacy of 100 mg diclofenac sodium analgesia of rectal suppository is better than 100 mg tramadol rectal suppository, with smaller side effects within 24 hours after surgery.