PERBANDINGAN EFEK PEMBERIAN BUPIVAKAIN 0,125%

KONTINYU DENGAN OKSIKODON 0,1 MG/KGBB PEREPIDURAL

TERHADAP KADAR KORTISOL PLASMA PADA PASIEN
PASCAOPERASI EKSTREMITAS BAWAH

USULAN PENELITIAN TESIS

Sebagai salah salah satu syarat untuk memperoleh gelar

Spesialis Anestesiologi dan Terapi Intensif

Oleh:
Pirma Ivan Ricky Manurung
04102781520006

PROGRAM PENDIDIKAN DOKTER SPESIALIS

FAKULTAS KEDOKTERAN
UNIVERSITAS SRIWIJAYA
2020
 PERBANDINGAN EFEK PEMBERIAN BUPIVAKAIN 0,125%
KONTINYU DENGAN OKSIKODON 0,1 MG/KGBB PEREPIDURAL
TERHADAP KADAR KORTISOL PLASMA PADA PASIEN
PASCAOPERASI EKSTREMITAS BAWAH

Oleh :
Pirma Ivan Ricky Manurung
04102781520006

USULAN PENELITIAN TESIS

Untukmemenuhi salahsatusyaratgunamemperolehgelar
SpesialisAnestesiologidanTerapiIntensif
Telahdiujiolehtimpengujidandisetujuiolehpembimbing

Palembang, Agustus 2020

Pembimbing I
Zulkifli, dr, SpAn.KIC, Mkes, MARS
NIP:196503301995031001

Pembimbing II
Agustina Br.Haloho, dr, SpAn, M.Kes.KIC
NIP: 196808072008012017

Pembimbing III
Legiran, Dr, dr, M.Kes
NIP: 197211181999031002

Mengetahui,

Ketua Bagian Anestesi dan TerapiIntensif Ketua Program StudiAnestesidanTerapi

Intensif
 Rose Mafiana, DR, dr., SpAn, KNA, KAO, Mkes Zulkifli, dr., SpAn, KIC, Mkes, MARS
NIP:19641151995032001 NIP: 196503301995031001

DAFTAR ISI
HALAMAN JUDUL..............................................................................................i
LEMBAR PERSETUJUAN..................................................................................ii
DAFTAR ISI..........................................................................................................iii
DAFTAR SINGKATAN........................................................................................vi
DAFTAR TABEL..................................................................................................vii
DAFTAR GAMBAR..............................................................................................viii

BAB I PENDAHULUAN
1.1 Latar belakang....................................................................................................1
1.2 Rumusan Masalah..............................................................................................5
1.3 Tujuan penelitian...............................................................................................5
1.3.1 Tujuan umum.............................................................................................5
1.3.2 Tujuan khusus............................................................................................5
1.4. Manfaat penelitian............................................................................................6
1.4.1 Manfaat praktis...........................................................................................6
1.4.2 Manfaat akademis......................................................................................6

BAB II KAJIAN PUSTAKA, KERANGKA PEMIKIRAN DAN HIPOTESIS

2.1 Kajian Pustaka...................................................................................................7
2.1.1Nyeri.....................................................................................................7
2.1.1.1Klasifikasi Nyeri......................................................................7
2.1.1.1.1 Nyeri Berdasarkan Lokasi.......................................7
2.1.1.1.2 Nyeri Berdasarkan Waktu........................................7
2.1.1.1.2.1 Nyeri akut...............................................9
2.1.1.1.2.1 Nyeri kronik............................................9
2.1.1.1.2 Nyeri Berdasarkan Etiologi.....................................10
2.1.1.2 Mekanisme Nyeri...................................................................13
 2.1.1.3 Faktor yang Memengaruhi Nyeri Pasca Operasi....................17
2.1.2 Kortisol................................................................................................20
2.1.2.1 Fisiologi Kortisol....................................................................20
2.1.2.2 Pengaruh Nyeri Pembedahan terhadap Kadar
Kortisol Plasma......................................................................22
2.1.3 Analgesia Epidural..............................................................................25
2.1.3.1 Definisi...................................................................................25
2.1.3.2 Obat-Obatan untuk Analgesia Epidural..................................26
2.1.3.3 Efek fisiologis Analgesia Epidural.........................................26
2.1.3.3.1 Efek Analgesia Epidural terhadap
Kardiovaskular dan Hemodinamik..........................27
2.1.3.3.2 Efek Analgesia Epidural terhadap Respirasi...........27
2.1.3.3.3 Efek Analgesia Epidural terhadap Gastrointestinal..27
2.1.3.3.4 Efek Analgesia Epidural terhadap Genitourinari.....28
2.1.3.4 Teknik Analgesia Epidural.....................................................29
2.1.3.5 Komplikasi Tindakan Analgesia Epidural..............................30
2.1.3.6 Bupivakain..............................................................................33
2.1.3.6.1 Farmakokinetik........................................................33
2.1.3.6.2 Farmakodinamik......................................................33
2.1.3.7 Oksikodon...............................................................................34
2.1.3.7.1 Farmakokinetik........................................................34
2.1.3.7.2 Farmakodinamik......................................................35
2.1.3.7.3 Efek Samping...........................................................36
2.2. Kerangka Pemikiran ........................................................................................37
2.3. Premis dan Hipotesis........................................................................................42
2.4. Kerangka Teori.................................................................................................42
2.5. Kerangka Konsep..............................................................................................43

BAB III METODE PENELITIAN

3.1 Rancangan penelitian.......................................................................................43
3.2.Waktu dan Tempat Penelitian.........................................................................43
3.2.1 Waktu penelitian....................................................................................43
3.2.2 Tempat penelitian..................................................................................43
3.3. Populasi dan Sampel.......................................................................................43
 3.3.1 Populasi.................................................................................................43
3.3.2 Sampel...................................................................................................44
3.4 Kriteria Inklusi dan Eksklusi...........................................................................44
3.4.1 Kriteria Inklusi......................................................................................44
3.4.2 Kriteria Eksklusi....................................................................................44
3.4.3 Kriteria Dropout....................................................................................45
3.5 Besaran Sampel...............................................................................................45
3.6 Cara Pengambilan Sampel...............................................................................46
3.7 Variabel Penelitian..........................................................................................46
3.8 Cara Kerja dan Teknik Pengumpulan Data.....................................................46
3.8.1 Pemilihan Alat dan Obat.......................................................................47
3.8.2 Tata Cara Penelitian..............................................................................47
3.9 Definisi Operasional........................................................................................51
3.10 Parameter Keberhasilan.................................................................................55
3.11 Rencana Analisis Data...................................................................................55
3.11.1 Pengolahan Data...............................................................................55
3.11.2 Analisis Data.....................................................................................55
3.12Alur Penelitian................................................................................................57
3.12 Rancangan Tabel...........................................................................................58
3.13 Rencana Penelitian........................................................................................58
3.14 Biaya Penelitian.............................................................................................58
3.15 Tim Penelitian...............................................................................................62

BAB IV JUSTIFIKASI ETIK

4.1. Rangkuman Karakteristik Penelitian..............................................................63
4.2. Prosedur Informed Consent............................................................................64
4.3. Analisis Kelayakan Etik.................................................................................65
4.4. Simpulan.........................................................................................................65

DAFTAR PUSTAKA..........................................................................................65
 DAFTAR SINGKATAN

IASP = International Association for the Study of Pain

SSP = Sistem Saraf Pusat

SST = Sistem Saraf Tepi

ACTH = Adrenocorticotropic hormone

CRF = Corticotropin releasing factor

NRS = Numeric Rating Scale

cAMP = Cyclic Adenonsine Monophosphate

IM = Intramuscular

IV = Intravena
 DAFTAR TABEL

Tabel 2.1 Macam-Macam Analgesia Epidural......................................................18

Tabel 3.3 Distribusi Frekuensi Subjek Penelitian pada Tiap-Tiap Kelompok......49

Tabel 3.4 Perbandingan Rerata Pemberian Bupivakain 0,125% kontinyu dengan

Oksikodon 5 mg terhadap Peningkatan Kadar Kortisol Plasma........... 50

Tabel 3.5Efek Samping Analgesia Epidural.........................................................50

Tabel 3.6 Visual Analog Scale..............................................................................51

Tabel 3.7 Rencana Penelitian................................................................................51

 DAFTAR GAMBAR

Gambar 2.1 Jalur Tranmisi Nyeri...........................................................................9

Gambar2.2 Mekanisme Regulasi Sekresi Kortisol...............................................13

Gambar 2.3 Irama Sekresi Kortisol......................................................................14

Gambar 2.4 Arah Jarum untuk Pendekatan Midline dan Paramedian..................21

Gambar 2.5 Kerangka Teori.................................................................................32

Gambar 2.6 Kerangka Konsep..............................................................................33

Gambar 3.1 Alur Penelitian..................................................................................48