Oleh admin kalbemed pada May 08, 2013 06:45

Parasetamol IV Mempunyai Efek Analgesik lebih Baik daripada Oral

Tatalaksana nyeri adalah bagian yang penting dalam perawatan pascaoperasi. Tatalaksana nyeri yang baik dengan konsumsi analgesik yang adekuat dapat mempercepat mobilitas, lama rawat di rumah sakit, dan juga menurunkan risiko terjadinya morbiditas. Dari sebuah survey yang dilakukan oleh sebuah studi menyebutkan hampir 80% pasien yang menjalani pembedahan ortopedi mengalami nyeri derajat sedang hingga berat. Dalam tatalaksana nyeri, umumnya pemberian obat nonopioid analgesik (contoh: paracetamol) diberikan secara tunggal atau dikombinasikan dengan golongan opioid (contoh: morphine).

Propacetamol merupakan bentuk prodrug dari paracetamol yang secara cepat di hidrolisis di dalam darah oleh enzim esterase untuk dirubah menjadi paracetamol. Dalam beberapa studi menunjukkan 2 g propacetamol intravena secara bioequivalen sebanding dengan 1 g paracetamol intravena. Propacetamol infus merupakan sediaan intravena pertama untuk paracetamol infus yang terdahulu sering digunakan sebagai salah satu regimen untuk tatalaksana nyeri. Pada saat ini, telah terdapat ready-to-use paracetamol infus di dalam vial sehingga tidak diperlukan lagi konstitusi seperti halnya yang diperlukan pada sediaan propacetamol.

Sebuah studi secara acak, tersamar ganda, dan multisenter  dengan kontrol plasebo dilakukan terhadap 323 pasien yang menjalani pembedahan HV untuk mengetahui efikasi dari propacetamol IV vs paracetamol oral. Pasien secara acak dibagi menjadi 3 kelompok dan diberikan 2 g propacetamol IV (setara dengan 1 g paracetamol IV – Kelompok PR), 1 g paracetamol oral (Kelompok PA), dan plasebo (sediaan oral dan IV – kontrol). Efek analgesik diukur dengan 5-point verbal scale selama 5 jam pascaoperasi.

Berikut adalah hasil dari studi tersebut: Kelompok PR dan PA secara bermakna lebih superior dalam hal tatalaksana nyeri jika dibandingkan dengan kontrol (p<0,05). PR secara bermakna memiliki penurunan nyeri  yang lebih baik jika dibandingkan dengan PA pada T30 (30 menit pascaoperasi) sampai T4 jam (p<0,01). Secara umum PR memberikan efikasi yang lebih baik dan efek analgesik yang lebih lama secara bermakna jika dibandingkan dengan PA dan kontrol (p<0,05). Efek yang tidak diinginkan yang dijumpai adalah 3 pada kelompok PR (nyeri pada tempat suntikan, sakit kepala, dan muntah), 6 pada kelompok PA (mual, tremor, nyeri pada tempat suntikan, dan malaise), 1 pada kontrol (nyeri pada tempat suntikan).

Kesimpulan: Propacetamol 2 g infus intravena yang sebandingan dengan paracetamol 1 g infus intravena secara bermakna memiliki efikasi yang lebih baik dan efek analgesik yang lebih lama jika dibandingkan dengan dosis yang sama pada sediaan oral.(MAJ)



Image: Ilustrasi
Referensi :
1.Nix SE, Vicenzino BT, Smith MD. Foot pain and functional limitation in healthy adults with hallux valgus: A cross-sectional study. BMC Musculoskelet Disord. 2012;13(1):197-218.
2.Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology 2005;102(4):822-31.
3.Jarde O, Boccard E. Parenteral versus Oral Route Increases Paracetamol Efficacy. Clin Drug Invest. 1997;14(6):474-81.



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