The efficacy of intravenous paracetamol versus tramadol for postoperative analgesia after ...

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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



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;



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



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



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;



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



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



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



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&in; '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&



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



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;

Refrensi

I1 arr et , lahault A, *a"a"a C, .onnet ; ff ects of

!osto!eratie, 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 eff icacy 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 , ubray C;

Analgesic effect of aceta"ino!hen in hu"ans6 fir st ei#ence of a

central 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 , :RRr Rnie"i $, i& anne , Annila ;

Analgesic efficacy of rectal aceta"ino!hen an# i bu!r ofen alone or in

co" bination f or !ae#iatric #ay<case a#enoi#ecto"y; .r J Anaesth

2003163=3<7;I a !!as A, lu#er , Cr eech *, $otaling A, ar & A; osto!er atie

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

intraenous !araceta"ol in chil#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, Autr et<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#r ete JA; The !ost<anesthesia r ecoer y scor e r eisite#; J Clin Anesth

1576@<1;

I13 $annallah - *, .r oa#"an , .el"an A., A bra"oit+ , !stein

.*; Co"!ar ison of cau#al an# ilioinguinal>iliohy!ogastr ic 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!er atie !ain r elief in chil#r en 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# r an#o"i+e# stu#y of tr a"a#ol s; !ar aceta"ol in analgesia af ter

#ay<case tonsillecto"y in chil#r en; ur J Anaesthesiol 2000176

57=<@2;

I1@ Alhashe"i JA, aghistani ; ffects of intrao!eratie i;;

aceta"ino!hen s i;"; "e !eri#ine on !ost<tonsillecto"y !ain in

chil#r en; .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 relief an# safe

r ecoer y after a#enotonsillecto"y; ur J Anaesthesiol 200320620<;

I20 4o&& i $, *alonen A; Co"!arison of !re< an# !osto!eratie

a#"inistration of & eto!r ofen f or analgesia after tonsillecto"y in

chil#r en; ae#iatr Anaesth 20021261=2<7;

I21 anarese A, Clar & e -L, %ar #ley ; arly !ost<o!eratie "or bi#ity

f olloing tonsillecto"y in chil#ren6 i" !lications f or #ay sur ger y;

J ar yngol Otol 1113610@<1;

I22 Ang C, $a br e L, *i"s C; Tr o!isetr on r e#uces o"iting after

tonsillecto"y in chil#ren; .r J Anaesth 1@@067=1<3;

I23 ah ., -obb J, - a ; osto!eratie !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 $; 9ntr ao!er atie

loa#ing attenuates nausea an# o"iting of tra"a#ol !atient<contr olle#

analgesia; Can J Anaesth 200076=@<73;

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