Muhammad Ramli Ahmad
Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Hassanudin University-Dr. Wahidin Sudirohusodo General Hospital

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Pengaruh Preventif Multimodal Analgesia Terhadap Dinamika Kadar Il - 1β, Intensitas Nyeri Pada Pascabedah Laparotomi Ginekologi Hisyam, Muhammad; Bahar, Burhanuddin; Ahmad, Muhammad Ramli
JAI (Jurnal Anestesiologi Indonesia) Vol 5, No 2 (2013): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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 Background: Postoperative pain is an extremely important issue facing patientspostoperative. Although our knowledge of the mechanisms of postoperative pain hasbeen a lot of progress, but not yet optimal management of postoperative pain and stilloften neglected. Interleukin (IL) 1β is one of the proinflammatory cytokine levels willrise when the inflammatory process.Objective: This study aims to compare the level of IL-1β between the group receivingepidural bupivacaine 0.125% combined with 40 mg parecoxibe and the one treatedwith epidural bupivacaine 0.125% used as multimodal preventive analgesia aftergynecological laparotomy operation.Method: A randomised double blind experiment was administered to 50 patients withphysical status (ASA PS) II who would experience gynecological laparotomyprocedure with epidural anesthesia. The study subjects were divided into twotreatment groups, one with a combination between epidural bupivacaine 0,125% andparecoxib 40 mg (n = 25) and the other one with a placebo combination with NaCl0,9% (n = 25). Each would have epidural anesthesia during operation and thepostoperative analgesia. Thirty-five minutes before surgery, the patients’ bloodsample was taken for IL-1β level measurement and so was at 2 and 24 hours aftersurgery. Statistical analysis used statistical software, Mann-Whitney U test and Levanetest.Result: Average level of IL-1β in parecoxib group was 1,05±1,25 pg/mlpreoperatively, 1,24 ± 1,54 pg/ml 2 hours postoperative and 1,82 ± 2,16 pg/ml 24hours postoperative. In control group, IL-1β level was 1,65±1,69 pg/ml preoperatively,2,55±2,77 pg/ml 2 hours postoperative and 1,96±1,97 pg/ml 24 hours postoperative.Average NRS score between resting and moving was not significantly different at 2, 12and 24 hours postoperative (p>0,05).Conclusion: Combination of epidural bupivacaine 0,125% with parecoxibe 40 mgdecrease IL-1β level at 2 hour after the surgery. Keywords : Bupivacaine, Epidural , IL-1β, Laparotomy Gynecology, Parecoxib  Latar Belakang: Nyeri pascabedah merupakan permasalahan sangat penting yangdihadapi pasien pascabedah. Meskipun pengetahuan kita tentang mekanisme nyeripascabedah sudah mengalami banyak kemajuan, namun pengelolaan nyeripascabedah belum optimal dan masih sering terabaikan. Interleukin (IL) 1β adalahsalah satu sitokin proinflamasi yang kadarnya akan meningkat bila terjadi prosesinflamasi.Tujuan: Penelitian ini bertujuan untuk membandingkan kadar IL-1β, skala NRS, padakelompok yang mendapatkan epidural bupivakain 0,125% kombinasi parecoxib 40 mgdengan kelompok yang mendapatkan epidural bupivakain 0,125% yang digunakansebagai multimodal preventif analgesia pascabedah laparotomi ginekologi.Metode: Penelitian eksperimental dilakukan secara acak pada 50 pasien denganstatus fisik (ASA PS) II yang akan menjalani prosedur laparotomi ginekologi dengananestesi epidural. Subyek penelitian dibagi dalam dua kelompok perlakuan, yaknikelompok pertama dengan kombinasi parecoxib 40 mg (n=25) dan kelompok keduadengan kombinasi plasebo NaCl 0,9% (n=25). Kedua kelompok tersebut mendapatkananestesi epidural selama operasi dan sebagai analgesia pascabedah. Pengambilansampel darah pasien dilakukan 35 menit sebelum pembedahan untuk pengukurankadar IL-1 β, selanjutnya dilakukan pada 2 jam dan 24 jam pascabedah. Analisisstatistik menggunakan uji Mann-Whitney U dan Levane test.Hasil: Rerata kadar IL-1β prabedah pada kelompok parecoxib 1,05±1,25 pg/ml, 1,24± 1,54 pg/ml untuk 2 jam pascabedah dan 1,82 ± 2,16 pg/ml pada 24 jam pascabedah.Kelompok kontrol, kadar IL-1β prabedah 1,65±1,69 pg/ml, 2,55±2,77 pg/ml untuk 2jam pasca bedah pg/ml, dan 1,96±1,97 pg/ml pada 24 jam pascabedah. Tidak adaperbedaan bermakna rerata skor NRS diam dan bergerak 2 jam, 12 jam, dan 24 jampascabedah diantara kedua kelompok sampel (p>0,05).Kesimpulan: Kombinasi epidural bupivakain 0,125% dengan parecoxib 40 mg dapatmenurunkan kadar IL-1β pada 2 jam pascabedah.
Perbandingan Efek Pemberian Ketamin 0,15 Mg/Kgbb Iv Prainsisi dan Ketamin 0,15 Mg/Kgbb Iv Pascabedah terhadap Kebutuhan Analgesik Morfin Pascabedah pada Pasien Operasi Ortopedi Ekstremitas Bawah Room, Asyikun Nasyid; Tanra, A Husni; Ahmad, Muhammad Ramli; Arif, Syafri Kamsul; Ilhamjaya, .
JAI (Jurnal Anestesiologi Indonesia) Vol 6, No 1 (2014): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Latar Belakang : Ketamin telah digunakan sebagai analgesia perioperatif sejak lama. Namun cara pemberian yang efektif masih belum jelas.Tujuan : membandingkan efek pemberian ketamin prainsisi, selama operasi dan 24 jam pascabedah dengan pemberian ketamin selama 24 jam pascabedah terhadap kebutuhan morfin pascabedah.Metode : Penelitian ini merupakan uji tersamar acak ganda. Total sampel 50 dibagi dalam 2 kelompok pasien dengan operasi ortopedi ekstremitas bawah dengan anestesi spinal. Kelompok pertama, mendapatkan ketamin 0,15 mg/kgBB IV prainsisi + 0,1 mg/kg/jam selama operasi dan 24 jam pascabedah.  Kelompok kedua mendapatkan ketamin 0,15 mg/kgBB IV pascabedah + 0,1 mg/kg/jam selama 24 jam pascabedah. Kedua kelompok mendapatkan analgesia pascabedah morfin via patient-controlled analgesia dengan loading dose 2 mg, bolus dose 1 mg dan lockout interval 7 menit. Jangka waktu pemberian morfin pertama pascabedah dihitung dari akhir operasi hingga saat pemberian morfin loading dose atas permintaan pasien; konsumsi morfin pascabedah dihitung dalam 24 jam.Hasil : Tidak ada perbedaan yang bermakna di antara kedua kelompok baik dalam waktu pemberian analgesik pertama (p=0,055) maupun konsumsi morfin dalam 24 jam (p=0,351).Simpulan : Ketamin tidak memiliki efek analgesia preventif pada pasien yang menjalani anestesi spinal.
Multimodal Analgesic Effect on Proinflammatory and Anti-inflammatory Cytokines Serum Ahmad, Muhammad Ramli; Bisri, Tatang
International Journal of Integrated Health Sciences VOL 2, NO 1, July (2014)
Publisher : International Journal of Integrated Health Sciences

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Objective: To investigate the effect of combination epidural bupivacaine and intravenous parecoxib analgesia on  immune response in patients who underwent open reduction and internal fixation of the lower limb under epidural anesthesia.  Methods: This research was conducted using the randomized, placebo-controlled double blind trial method on 52 patients who were randomly divided into 2 groups: the Parecoxib group which received 40 mg intravenous parecoxib for 30 minutes before incision and the control group which received an equal volume of 0.9% normal saline. Both groups received epidural anesthesia and postoperative epidural 0.125% bupivacaine analgesia continously. Venous blood samples were obtained before parecoxib administration, 2 and 24 hours after the surgery. The data were analyzed using Mann Whitney U and Independent t tests (p<0.05).     Results: There was a significant difference between the two groups (p<0.05) in IL-1β, IL-6, IL-10 levels and proinflammatory to anti-inflammatory ratio, 2 hours after surgery.    Conclusions: Multimodal analgesic combination of 40 mg IV parecoxib and 0.125% bupivacaine epidural analgesia have the effect to alter and stabilize the  systemic immune response.    Keywords: Cytokines, epidural analgesia, interleukins, immune response, parecoxib, tissue damage DOI: 10.15850/ijihs.v2n1.272
Pengaruh Pemberian Parecoxib Terhadap Kadar Il-6 dan Intensitas Nyeri Pascabedah Laparotomi Ginekologi Haeruddin, Heriady; Ahmad, Muhammad Ramli
JAI (Jurnal Anestesiologi Indonesia) Vol 5, No 2 (2013): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Background : Post operative pain still an issue in the post operative management.Approximately 80% patients undergo surgery has had acute post operative pain whichhipothetically mediated by interleukin 6 (IL-6): a proinflamation cytokine that hasimportant role in pain physiology. Objective : The aim of this research is to measure Interleukin 6 (IL-6) concentration andpost operative pain intensity in the use of combination Parecoxib 40 mg intravenouswith epidural analgesic bupivakain and fentanyl for patients undergo gyneacologylaparotomy. Methods : This is an experimental research using double blind random technique.Total sample 50, which divided into 2 groups consist of 25 subjects each which haddone gyneacologic laparotomy. One group had Parecoxib 40 mg before surgery and12 hours after surgery, while the control group had placebo. Both of groups hadepidural analgesic using bupivacain 0,5% and fentanyl, and post operative analgesiccontinuous with bupivacain 0,125% and fentanyl 2 ug/ml 5 ml/hour. The painasessment using NRS chart at 2, 12, and 24 hours post operative. Result : IL-6 serum on both groups had elevation with the peak level on 24 hours postoperative. No significant difference in IL-6 serum elevation (p>0,05). No differencealso in assessment post operative pain scale using NRS chart in both groups. Conclusion : Analgesic combination between Parecoxib 40 mg IV with epiduralanalgesic bupivacain 0,125% can’t lower IL-6 patient serum who undergogynecologic laparotomy. Latar Belakang : Nyeri pascabedah masih merupakan masalah dalam periodepascabedah. Sekitar 80% pasien yang menjalani pembedahan mengalami nyeri akutpascabedah. Interleukin-6 (IL-6) merupakan sitokin proinflamasi yang berperanpenting dalam fisiologi nyeri. Tujuan : Penelitian ini bertujuan mengukur kadar IL-6 dan intensitas nyeripascabedah pada penggunaan kombinasi Parecoxib 40 mg intravena dengananalgesia epidural bupivacain dan fentanyl pada pasien yang menjalani laparotomiginekologi. Metode : Dilakukan penelitian eksperimental secara acak pada 50 pasien yang dibagimenjadi dua kelompok, masing-masing 25 subyek yang menjalani bedah laparotomiginekologi. Sebelum dan 12 jam setelah pembedahan Kelompok Parecoxibmendapatkan Parecoxib 40 mg sedangkan Kelompok Kontrol mendapatkan plasebo.Pada kedua kelompok mendapatkan anestesi selama pembedahan dengan anestesiepidural bupivacain 0,5% dan fentanyl dilanjutkan analgesia epidural pascabedahkontinu dengan bupivacain 0,125% dan fentanyl 2 ug/ml 5 ml/jam. Penilaian nyeridengan NRS diam bergerak dan dilakukan pada 2 jam, 12 jam, dan 24 jampascabedah. Hasil : Pada IL-6 serum pada kedua kelompok mengalami peningkatan dengan kadarpuncak pada pengukuran 24 jam pascabedah. Tidak ada perbedaan peningkatankadar IL-6 antara kedua kelompok (p>0,05). Demikian pula pada penilaian skalanyeri dengan NRS diam dan bergerak, tidak ditemukan perbedaan antara keduakelompok. Kesimpulan : Kombinasi analgesia parecoxib 40 mg iv dengan analgesia epiduralbupivacain 0,125% tidak dapat menurunkan kadar IL-6 serum pada pasien yangmenjalani laparotomi ginekologi.
Perbandingan Efek Analgesia Pascabedah dan Stabilitas Kadar Gula Darah antara Bupivakain 0,5% 7,5 mg + Klonidin 30 mg dengan Bupivakain 0,5% 7,5 mg + Fentanil 25 mg Intratekal Pasien yang Menjalani Seksio Sesarea , Masrianil; Wahab, Abdul; Gaus, Syafruddin; Ahmad, Muhammad Ramli; Seweng, Arifin
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
Publisher : Perdatin Pusat

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Penelitian ini bertujuan membandingkan efek analgesia pascabedah dan stabilitas kadar gula darah antara bupivakain 0,5% 7,5 mg+klonidin 30 μg dengan bupivakain 0,5% 7,5 mg+fent anil 25 μg intratekal pada pasien yang menjalani seksio sesaria. Penelitian ini menggunakan metode uji klinis acak tersamar tunggal dengan 50 sampel di Rumah Sakit Fatimah Makassar dan jejaringnya. Pemeriksaan kadar gula darah dilakukan sebelum spinal, 10 menit setelah operasi dan 1 jam setelah operasi selesai. Data dianalisis dengan menggunakan sistem Statistical Package for the Social Scien Tu program (SPSS). Hasil penelitian menunjukkan bahwa durasi analgesia kelompok bupivakain klonidin (BK) (322,08±34,53) menit lebih lama dibandingkan kelompok bupivakain fentanil (186,72±16,45) menit, secara statistik dinyatakan bermakna (p&lt;0,05). Perbandingan kadar gula darah (GD) kelompok BF dan BK menghasilkan kadar GD yang stabil yaitu kelompok BF menghasilkan kadar GD sebelum spinal (122,40±18,34) mg/dl, 10 menit setelah operasi dimulai (114,88±23,31) mg/dl, dan 1 jam post operatif (128,04±21,91) mg/dl, sedangkan pada kelompok BK menghasilkan kadar GD sebelum spinal (118,96±15,99) mg/dl, 10 menit setelah operasi mulai (109,48±10,08)mg/dl,1 jam setelah operasi selesai (122,24±18,14) mg/dl. Secara statistik perbandingan rata-rata GD kedua kelompok tidak bermakna pada kedua kelompok (p&gt;0,05). Kata kunci: Bupivakain, efek analgesia pascabedah, fentanil, kadar gula darah, klonidin, seksio sesarea The Comparison of The Analgesic Post Operatif and Blood Glucose Stability Effects Between Bupivacain 0,5% 7,5 mg + Clonidin 30 mg and Bupivacain 0,5% 7,5 mg + Fentanyl 25 mg Intrathecal in Patients Undergoing Caesarean Section The study aims to compare the effect of bupivacaine 0,5% 7,5 mg+clonidin 30 μg and bupivacaine 0,5% 7,5 mg+Fentanyl 25 μg on the analgesia and blood glucose stability of the intrathecal patient during caesarean section. This study used single-blind method and 50 samples in Fatimah Maternity Hospital in Makassar and its networking maternity hospitals. Blood glucose examination was made before spinal, 10 minutes after operation and 1 hour after the operation. The data were analysed with SPSS program. The result indicates that the duration of analgesia in Bupivacaine Clonidin group (BK) (322.08±34,53) minute longer than Bupivacaine Fentanyl group (BF) (186.72±16,45) minute. The difference is statistically significant (p&lt;0,05). The comparison of both blood glucoses indicates stable blood glucose levels (BG). In the group of BF, the glucose level before spinal (122.40±18.34) mg/dL, 10 minutes after operation (114.88±23.31)mg/dL, and 1 hour after operation (128.04±21.91) mg/dL. In the group of BK, the glucose level before spinal (118.96±15.99)mg/dl, 10 minutes after operation (109.48±10.08 )mg/dL, and 1 hour after operation (122.24±18.14) mg/dL. The comparison between the average of both groups blood glucose is statistically insignificant (p&gt;0.05). Key words: Analgesic post operatif, blood glucose level, bupivacain, clonidine, fentanyl, caesarean section Reference Agrawal A. Comparison of intrathecal fentanyl in addition to bupivacaine for caesarean section under spinal anaesthesia. J Anaesth Clin Pharmacol. 2009;25(2):154-6. Bhure A. Kalita N, Ingley D, Gadkari CP. Comparative study of intrathecal hyperbaric bupivacaine with clonidine, fentanyl and midazolam for quality of anaesthesia and duration of post operative pain relief in patients undergoing elective caesarean section. People Journal of Sciene Research. 2012;5(1):19–23. Bhushan S B, Suresh J S, Vinayak SR , &amp; Lakhe, J.N. Comparison of different doses of clonidine as an adjuvant to intrathecal bupivacaine for spinal anesthesia and postoperative analgesia in patients undergoing caesarian section. Anaesth, Pain &amp; Intensive care. 2012;16(3):266–72 Bintaro A , Pryambhodo, Susilo. Keefektifan anestesi spinal menggunakan bupivakain 0,5% hiperbarik 7,5 mg ditambah fentanil 25 mcg dibandingkan dengan bupivakain 0,5% hiperbarik 12,5 mg pada bedah sesar. Anestesia &amp; critical care. 2010;28:9–17. Biswas B N, Rudra, A, &amp; Bose, B K. Intrathecal fentanyl with hyperbaric bupivacaine improves analgesia during caesarean delivery and in early post-operative period. Indian J Anaesth. 2002;46(6):469–72. Bogra J, Arora N, Srivastava P. Synergis effect of intrathecal fentanil and bupivacaine in spinal anesthesia for cesarean section. BMC Anesthesiol. 2005;5:5. Bouwmeester N.J. Hormonal and metabolic stress responses after major surgery in children aged 0–3 years: a double-blind, randomized trial comparing the effects of continous versus intermitten morphine. Br J Anaesth.2001;87:390–9. Dobrydnjov I Axelsson, K., Matthiesen P, Klockhoff H., Holmstrom, B. Clonidine combined with small-dose bupivacaine during spinal anesthesia for inguinal hernioraphy: a randomized double blinded study. Anesth Analg. 2003;96:1496-503. Ganong WL. Review of medical physiology. Edisi ke-20. New York:McGraw-Hill, 2001. hlm. 322–43. Hayashi Y Maze, M. Alpha drenoceptor agonists and anaesthesia. Br J Anaesthesia.1998;71:108–18. Hocking G ,Wildsmith J.A. Intrathecal drug spread. British J Anesth. 2004; 93(4):568–78. Prasetyo A H. Efek Klonidin sebagai ajuvan anestesi spinal terhadap kadar glukosa darah [Tesis]. Surakarta. 2011. Stoelting R K,Hillier, S.C. Pharmacology &amp; physiology in anesthetic practice. Edisi ke-4. Philadelphia: Lippincott Williams &amp; Wilkins. Hlm.190. Vadivelu N, Whithney, C J, Sinatra R.S. Pain pathway and acute pain processing. Dalam : Sinatra R S, Leon C O, Ginsberg, B, &amp; Viscusi, E.R., penyuntingAcute pain management. New York: Cambridge University Press, 2009. hlm. 3–12.
Multimodal Analgesic Effect on Proinflammatory and Anti-inflammatory Cytokines Serum Ahmad, Muhammad Ramli; Bisri, Tatang
International Journal of Integrated Health Sciences Vol 2, No 1 (2014)
Publisher : International Journal of Integrated Health Sciences

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Abstract

Objective: To investigate the effect of combination epidural bupivacaine and intravenous parecoxib analgesia on  immune response in patients who underwent open reduction and internal fixation of the lower limb under epidural anesthesia.  Methods: This research was conducted using the randomized, placebo-controlled double blind trial method on 52 patients who were randomly divided into 2 groups: the Parecoxib group which received 40 mg intravenous parecoxib for 30 minutes before incision and the control group which received an equal volume of 0.9% normal saline. Both groups received epidural anesthesia and postoperative epidural 0.125% bupivacaine analgesia continously. Venous blood samples were obtained before parecoxib administration, 2 and 24 hours after the surgery. The data were analyzed using Mann Whitney U and Independent t tests (p<0.05).     Results: There was a significant difference between the two groups (p<0.05) in IL-1β, IL-6, IL-10 levels and proinflammatory to anti-inflammatory ratio, 2 hours after surgery.    Conclusions: Multimodal analgesic combination of 40 mg IV parecoxib and 0.125% bupivacaine epidural analgesia have the effect to alter and stabilize the  systemic immune response.    Keywords: Cytokines, epidural analgesia, interleukins, immune response, parecoxib, tissue damage DOI: 10.15850/ijihs.v2n1.272
Perbandingan Intensitas Nyeri dan Kadar Prostaglandin Kombinasi Tramadol dan Deksketoprofen dengan Tramadol dan Parasetamol Intravena pada Pasien Bedah Ortopedi Ekstremitas Bawah Josephine, Clara Valentia; Ahmad, Muhammad Ramli; Hisbullah, Hisbullah; Wahab, Abdul
Jurnal Anestesi Perioperatif Vol 7, No 2 (2019)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v7n2.1691

Abstract

Analgesia multimodal adalah prinsip manajemen nyeri pascaoperasi. Penelitian ini merupakan uji klinis rancangan acak tersamar ganda. Tujuan penelitian ini membandingkan efek kombinasi analgesik tramadol dan deksketoprofen dengan tramadol dan parasetamol terhadap intensitas nyeri dan kadar prostaglandin (PGE2) di RSUP Dr. Wahidin Sudirohusodo serta Rumah Sakit Jejaring di Makassar pada bulan Juli?September 2018. Empat puluh enam pasien ASA PS I dan II yang menjalani operasi ortopedi ekstremitas bawah dibagi menjadi dua kelompok. Kelompok D adalah pasien yang menerima 50 mg tramadol dengan 50 mg deksketoprofen dan kelompok P adalah pasien yang menerima 50 mg tramadol dengan 1.000 mg parasetamol intravena. PGE2 dan intensitas nyeri dicatat selama penutupan kulit sebelum pemberian obat 8 dan 16 jam sesudahnya. Data dianalisis menggunakan Uji Mann-Whitney U dan paired t-test yang sesuai. Numeric rating scale (NRS) kelompok tramadol dan deksketoprofen lebih rendah dibanding dengan kelompok tramadol dan parasetamol dengan perbedaan bermakna (p<0,05). Kadar PGE2 menurun pada kelompok tramadol dan deksketoprofen (T1?T2 p=0,009 dan T0?T2 p=0,01), sedangkan kadar PGE2 pada kelompok tramadol dan parasetamol meningkat (T2?T1 p=0,227 dan T0?T2 p=0,706). Simpulan, kombinasi tramadol dan deksketoprofen mengurangi tingkat PGE2 dan intensitas nyeri dibanding dengan kombinasi tramadol dan parasetamol.Kata kunci: Deksketoprofen, parasetamol, PGE2, tramadol