Download - Manajemen Nyeri-blok 20
![Page 1: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/1.jpg)
1
Erwin KresnoadiErwin Kresnoadi
![Page 2: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/2.jpg)
211
![Page 3: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/3.jpg)
“an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in term of such damage”.
Nyeri adalah rasa indrawi dan pengalaman emosional yang tidak menyenangkan akibat adanya kerusakan jaringan yang nyata atau yang berpotensi rusak, atau tergambarkan seperti itu.
DEFINISI NYERI
A Definitionof Painby John D.Loeser, M.D.
IASP (International Association for the Study of Pain) 1979 defined pain as :
H. Merskey
![Page 4: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/4.jpg)
4
NYERINYERI
AkutAkut
KronisKronis33
![Page 5: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/5.jpg)
5
Nyeri yang terjadi akibat adanya Nyeri yang terjadi akibat adanya
kerusakan jaringan yang nyata.kerusakan jaringan yang nyata.
(Pain with injury)(Pain with injury)
NYERI AKUTNYERI AKUT
44
![Page 6: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/6.jpg)
6
PENYEBABPENYEBABInflamasi / Kerusakan JaringanInflamasi / Kerusakan Jaringan
55
![Page 7: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/7.jpg)
7
MEKANISME NYERIMEKANISME NYERITRANSDUKSITRANSDUKSI
TRANSMISITRANSMISI
MODULASIMODULASI
PERSEPSIPERSEPSI66
![Page 8: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/8.jpg)
8
TRANSDUKSITRANSDUKSI
77
![Page 9: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/9.jpg)
9
TRANSMISITRANSMISIAction PotentialAction Potential
Electrical basis for signal Electrical basis for signal transmission within a nerve transmission within a nerve cell.cell.
Cell depolarizes due to a Cell depolarizes due to a change in internal ion change in internal ion concentration.concentration.
Depolarization travels down Depolarization travels down the axon away from cell the axon away from cell body.body.
88
![Page 10: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/10.jpg)
10
MODULASIMODULASI
Afferent Central Terminal
Glutamate
Sub P
Activity
NK1
mGluR
NMDA
AMPAAMPA
VGCCGABAA
AdensosineOpiateCB1
Dorsal Horn Neuron
99
![Page 11: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/11.jpg)
11
PERIPHERAL SENSITIZATIONPERIPHERAL SENSITIZATION
Innocuous/Noxiousstimulus
primary sensory neuron central neuron
Primary hyperalgesiaPrimary allodynia
Inflammation
Reduced Transduction Threshold
1010
![Page 12: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/12.jpg)
12
CENTRAL SENSITIZATIONCENTRAL SENSITIZATION
Noxiousstimulus
primary sensory neuron central neuron
Secondary hyperalgesiaTactile allodynia
IrritantsTissue damageInflammation
Increased Pain Responsiveness
1111
![Page 13: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/13.jpg)
13Descending pain pathway (Purves, 2001).
PERSEPSIPERSEPSIModulation of
Pain PerceptionThe Descending Pain Pathway – The Periaqueductal Grey is the major convergence point.
1212
![Page 14: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/14.jpg)
PERCEPTION
MODULATION
TRANSMISSION
TRANSDUCTION
OPIOID- Systemic- Epidural- Subarachnoid
LOCAL ANESTHETIC- Epidural- Subarachnoid
NSAIDs
PENGELOLAAN NYERI
![Page 15: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/15.jpg)
15
TARGET OF PAIN THERAPIESTARGET OF PAIN THERAPIES
Gottschalk et al., 2001
Alternative methodsAlternative methodsAcupuncturePhysical TherapyChiropracticsSurgery
PharmacotherapyPharmacotherapyNon-opioid analgesicsOpioid analgesics Nerve Blocks Adjuvant analgesics (neurophatic, musculoskeletal)NSAID
Electrical StimulationElectrical StimulationTranscutaneous electrical nerve stimulation (TENS)Percutaneous electrical nerve stimulation (PENS)
1313
![Page 16: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/16.jpg)
16
PERAN NSAIDsPERAN NSAIDs
1414
Normal Tissue Inflammation Site
Physiolgical ProstaglandinProduction
PathologicalProstaglandinProduction
COX-1Constitutive
COX-2Inducible
Arachidonic Acid
Normal Functions Inflammation, pain, fever
NSAIDs COX-2Inhibitors
+ CytokinesGrowth factors
![Page 17: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/17.jpg)
Treatment pain cheklist• Understand the pain pathway• Understand the proposed procedure• Understand possible pain treatment options• Review previous records of pain treatment• Identify contraindications to treatments• Review the impact of coexisting disease
processes• Discuss options with the patient • Discuss options with the surgeon• Considere the risk/benefits for each option
![Page 18: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/18.jpg)
18
1515
![Page 19: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/19.jpg)
19
![Page 20: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/20.jpg)
20
Recommendations Grade A :Recommendations Grade A :
NSAID are not sufficiently effective as the sole agent after major surgery in most patients
But are often effective after minor to moderate surgery
NSAID decrease opiod requirement ( decrease side effect of opioid)
Quality of opiod analgesia is often enhance by NSAID
In situation where there are no contraindications, NSAID are the drug of choice after many day case procedure
1717
![Page 21: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/21.jpg)
21
1.1. Nyeri akut diobati secepat mungkin. Nyeri akut diobati secepat mungkin.
2.2. Pada nyeri berat, perlu kombinasi :Pada nyeri berat, perlu kombinasi :
NSAIDNSAID
OpiatOpiat
3.3. Perlu pendekatan psikologi. Perlu pendekatan psikologi.
KESIMPULANKESIMPULAN
1818
![Page 22: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/22.jpg)
A close relationship between the surgeon & anesthesiologist
![Page 23: Manajemen Nyeri-blok 20](https://reader030.vdokumen.com/reader030/viewer/2022012323/577cc3d81a28aba711974f6a/html5/thumbnails/23.jpg)