Oleh:
Anggun Nurul Fitria, S.Ked
04084821517137
Risma Arnis Putri, S.Ked
04054821618028
Hatina Agsari, S.Ked
04084821618154
Pembimbing:
dr. Yusni Puspita, SpAn, KAKV, KIC, M.Kes
Pendahuluan
Nyeri
(The Internationl Association
for The Study of Pain 1979)
Definisi
Klasifikasi Nyeri
Nyeri akut
Nyeri Kronik
Cancer Pain
Chronic Non cancer pain
Nyeri nosiseptif
Nyeri somatik
Nyeri viseral
Nyeri Neuropatik
Nyeri Psikogenik
Type of Pain
Features
Acute pain
Chronic pain
Cancer pain
Gambaran nyeri akut, nyeri kronik, cancer pain, dan chronic non cancer pain.
ANS: Autonomic Nervous System (Sumber: Coda et al, 2001; Turk et al,
2001; Jacobsen et al, 2001; Dunajcik, 1999)
Mekanisme Nyeri
Reseptor
nyeri (Nosireseptor)
Kutaneus
30 m/det, bermielin.
Serabut C: kecepatan transmisi 0,5
m/det, tidak bermielin.
Nosiresptor
somatik:
Nosiresptor
Tissue
Injury
Viseral:
dan inflamasi.
Lanjutan..
Transduksi
Stimulus nosiseptor potensial aksi.
Transmisi
Konduksi impuls transmisi dari neuron aferen
SSC FLC
Cortex and
Thalamus
VPL
MT
Hypothalamus
and Pituitary
Sympathetic
Outflow
PAG
HypothalamicPituitary Outflow
Midbrain
LC
Descending
Pathaways
Ascending
Pathaways
Brainstem
NRM
Peripheral
Nociceptor
C-Fiber Sensory
Afferent
NSTT
Delta Sensory
Afferent
PSTT
Spinal Cord
Sympathetic
Efferent
A-Alpha Motor
Efferent
diubah?
Apakah manajemen nyeri paska operasi
perlu ditambah?
Adakah intervensi tambahan yang
diperlukan?
Keluhan
ketegorikal:
Manajemen Nyeri
Farmakologi
(WHO Three-step
Analgesic Ladder)
Langkah 1: nyeri sedang dan berat
Analgesik
Non Opioid
Mekanisme dan efek:
Menghambat enzim sikloksigenase (COX)
Lanjutan..
Sediaan dan dosis:
Oral, rectal, topikal dan parenteral.
Beberapa OAINS hanya dapat diberikan
1 kali sehari.
Efek Samping:
Gangguan traktus gastrointestinal
Generic Name
Indications
Acetaminophen
Aspirin (ASA)
Diflunisal
CMT (Choline
Magnesium
Trisalicylates)
ASA: q 4-6 h;
Diflunisal: q 8-12 h;
CMT: once per day
(QD), twice daily
(BID) or three times
daily (TID)
Ibuprofen
Naproxen
Ketoprofen
q 6-12 h
Capsules, ER capsules
Flurbipofen
OA, RA
Tablets
Oxaprozin
Caplets
Indomethacin
Piroxicam
Meloxicam
Diclofenac
OA
OA, RA, AS, primary
dismenorrhea
q 24 h
Tablets
BID, TID, QID (four Tablets, ER tablets
times daily), ER
form q 24 h
Ketorolac
Rofecoxib
q 24 h
Celecoxib
q 12 or 24 h
Capsules
Opioid
Opioid
Reseptor Opioid
Distimulasi
Kategori Opioid
Drug Enforcement Agency (DEA):
1. Phenanthrenes: Morfin, codeine,
2.
3.
4.
5.
hydromorphone.
Benzomorphan: Pentazocine.
Phenylpiperidines: Fentanyl, alfentanil,
sufentanil, dan meperidine.
Diphenylheptanes: Methadone.
Tramadol
Lanjutan..
Antagonis opioid:
Nalokson
Mengikat resptor opioid dan
menghambat pengaktifannya.
Generic Name
Indications
Routes of Administration
Potential Side Effects
and Dosage Forms
PO (IR and CR), PR, IV,
Mu agonist class side
SC, EA, IA, SL
effects, precautions,
warnings, and
contraindications
Metabolite can accumulate
in setting of RF or hepatic
dysfunction
Morphine
Hydromorphone
4-6 h for oral and parenteral PO, PR, IV, SC, EA, IA
6-8 h for rectal
Fentanyl
Oxycodone
Meperidine
3-4 h
Hydrocodone
PO
Codeine
4h
PO, SC
Endogenous Peptides
Enkephalins
Agonist
Agonist
-Endorphin
Agonist
Agonist
Dynorphin A
Agonist
Agonist
Morphine
Codein
Agonist
Weak Agonist
Fentanyl
Agonist
Meperidine
Agonist
Methadone
Agonist
Weak Agonist
Agonist
Antagonist
Naloxone
Antagonist
Weak Agonist
Naltrexone
Antagonist
Weak Agonist
Kesimpulan
Daftar Pustaka
Berry, PH., et al. 2001. Pain: Current Understanding of Assessment, Management, and Treatments. NPC and
JCAHO. Hlm. 1-101.
Butterworth, JF., Mackey, DC., & Wasnick, JD. 2013. Analgesic Agents, chapter 10. Dalam: Morgan & Mikhails
Clinical Anesthesiology, fifth edition. Hlm. 189-198. McGraw Hill Lange. New York.
Chou, R., et al. 2016. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain
Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of
Anesthesiologists Committee on Regional Anesthesia, Executive Committee, and Administrative Council. APS J,
17(2):131-157
Coda BA, Bonica JJ. 2001. General considerations of acute pain. Dalam: Loeser JD, Butler SH, Chapman CR, et
al, eds. Bonicas Management of Pain. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins;:222-240.
Donellan, Keith., et al. 2014. Analgetia and Sedation in the ICU, chapter 51. Dalam: Marinos The ICU Book,
fourth edition. Wolters Kluwer Health/Lippincott Williams & Wilkins. Philadelphia.
Dunajcik L. 1999. Chronic nonmalignant pain. Dalam: McCaffery M, Pasero C, eds. Pain Clinical Manual, 2nd ed.
St. Louis, MO: Mosby In; :467-521.
Hamza, M., and Dionne, RA. 2009. Mechanism of Non-Opioid Analgesics Beyond Cyclooxigenase Enzyme
Inhibition. Curr Mol Pharmacol; 2(1): 1-14
Jacobsen L, Mariano A. 2001. General considerations of chronic pain. Dalam: Loeser JD, Butler SH, Chapman CR,
et al, eds. Bonicas Management of Pain. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 241-254.
Rathmell, JP & Fields, HL. 2015. Pain: Pathophysioloogy and Management. Dalam: Kasper, DL et al (Editor).
Harrisons Principles of Internal Medicine, 19th edition. Hlm. 87-89. McGraw Hill Lange. New York.
Setiyohadi, B., dkk. 2014. Nyeri. Dalam: Sudoyo, W.A. (Editor). Buku Ajar Ilmu Penyakit Dalam Jilid III, edisi 5.
Hlm. 3115. Interna Publishing, Jakarta.
Terman GW, Bonica JJ. 2001. Spinal mechanisms and their modulation. Dalam: Loeser JD, Butler SH, Chapman
CR, Turk DC, eds. Bonicas Management of Pain. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins;:73-152.
Trescot AM, et al. 2008. Opioid Pharmacology. Pain Physician Journal. 11:133-153
Turk DC, Okifuji A. 2001. Pain Terms and taxonomies of pain. Dalam: Loeser JD, Butler SH, Chapman CR, et al,
eds. Bonicas Management of Pain. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins;:17-25.