analgesialabor

7/24/2019 AnalgesiaLabor

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Analgesia in Labor

International

ANALGESIA DALAM

PERSALINAN


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Analgesia in Labor

International

DUKUNGAN DALAM PERSALINAN :

Fasilitasi perubahan posisi dan

obilisasi Men!uran!i "eta"utan dan "e#easan

Mendu"un! "en$aanan

Pendapin!an


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Analgesia in Labor

International

%ara &ara"olo!is

Sistei"

Anal!esia nar"oti"a


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Analgesia in Labor

International

'L(K SARAF PERIFER

'lo" ner)us pudendus

In*ltrasi perineu

Anal!esia re!ional

Epidural


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Analgesia in Labor

International

Pain: The Fifth Vital SignPain: The Fifth Vital Sign

1.1. PulsePulse

2.2. Blood pressureBlood pressure

3.3. TemperatureTemperature

4.4. Respiratory rateRespiratory rate

Pain:Pain:

The FifthThe Fifth

Vital Sign Vital Sign11**

1American Pain Society Web site.

*Trademarks are the roerty of their resecti!e o"ners.


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Analgesia in Labor

International

Treatment of Pain: an Unmet Medical Need

Inadequately treated pain can have many negative effects on patients1

There is an urgent need for patient education about

pain management

Pain management is moving toward new treatments to meet physician and patientneeds

New guidelines from associations such as Europe Against Pain (EAP and the !oint

"ommission on Accreditation of #ealthcare $rgani%ations (!"A#$ underscore the

need for better pain management&'

1Cousins M et al. Textbook of Pain. 1999:447-491.2European Federation of IASP Capters. Europe A!ainst Pain "e# site. A$aila#le at: ttp:%%&&&.efi'.or!%eap.t(. A''essed )'to#er *1+ 2,,*.*Pillips M.JAMA. 2,,,2/4:42/-429.


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Analgesia in Labor

International

Potential Consequences of Poor

Pain Management

)ecreased motion1

0 Prolon!ed rea#ilitation

0 Mus'le atrop

0 Pneu(onia

Prolonged hospitali%ation1'&

Increased cost1'&

0 reater ospital resour'e utili3ation

Psychological impact1

Poor patient satisfaction1

1 #o$sins et al. Te%tbook of Pain. 1&&&:''()'&1. +imberg S,. Manag Care Q. --/11:')0.


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Analgesia in Labor

International

The Goals of Emergenc MedicineThe Goals of Emergenc Medicine

Pain ManagementPain Management!!

Meet the humanitarian need for "ain relief

Pro#ide ra"id diagnosis for immediate inter#ention

Pro#ide ra"id relief $ithout com"licating diagnosis or limiting

further treatment o"tions

1 #o$sins 2 Po"er 3. Ac$te and ostoerati!e ain. 3n: Wall P42 5el6ack 72 eds. Textbook of Pain.'thed. ,dinb$rgh289: #h$rchill i!ingstone/ 1&&&:''()'&1.


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Analgesia in Labor

International

Pain Sensiti%ationPain Sensiti%ation

Adated from ;ottschalk A et al.Am Fam Physician. --1/0:1&


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Analgesia in Labor

International

Pain TransmissionPain Transmission

SpinothalamicSpinothalamic

tracttractPeripheralPeripheral

nervenerve

Dorsal HornDorsal Horn

Dorsal rootDorsal root

ganglionganglion

PainPain

COX-2COX-2

COX-2COX-2

AscendingAscending

inputinput

DescendingDescending

modulationmodulation

PeripheralPeripheral

nociceptorsnociceptors

TraumaTrauma

Adated from ;ottschalk A et al.Am Fam Physician. --1/0:1&


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Analgesia in Labor

International

Treatment &"tions for 'cute andTreatment &"tions for 'cute and

Chronic PainChronic Pain

NS'()S

Nonspecific

C!"2 specific

&"ioids *ocal anesthesia

'd+uncti#e thera"

&ther


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Analgesia in Labor

International

*lufenamic Acid+efenamic Acid+eclofenamate

Klasifiasi !SA"Ds #erdasaran Strutur Kimia

Indomethacin,ulindacTolmetin

Acemethacin-idomethacin

Etodolac

Car#o$%lic acid

,alicilic and Ester

Acids

Phenylacetic Acid Indolacetic Acid Propionic Acid Phenamic Acid

Aspirin

)iflunisal

)iclofenac

Aceclofenac

*enclofenac

Ionacolac

+eti%inic

IbuprofenNapro.en

*lurbiprofen*enbrufen

/eno.aprofen*enoprofenIndoprofen0etoprofenPirprofen

Tiaprofenic Acid

Acid +NA

Alanos

Naphtylal2anone

Nabumetone

Sulphonanilide

+ethan,ulphonanilide

Nimesulide

$.yphenbuta%onePhenylbuta%one

*epra%one

$.icams

&nolic Acid

Pyra%olones

Piro.icamTeno.icam

+

Co$i#

"ele.ocib

3efe.ocib4aldeco.ib

Pareco.ib

Eteroco.ib


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F h C id i i P i,iF th C id ti i P i,i


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Analgesia in Labor

International

Further Considerations in Prescri,ingFurther Considerations in Prescri,ing

Nons"ecific NS'()sNons"ecific NS'()s

Gastrointestinal!-.

Pe"tic ulceration/ gastrointestinal hemorrhages Eso"hagitis and strictures Small and large ,o$el erosi#e disease

(nhi,ition of "latelet aggregation (ncreased ris0 of ,leeding

1e#ersi,le acute renal failure Fluid and electrolte distur,ance2edema Chronic renal failure and interstitial fi,rosis (nterstitial ne"hritis Ne"hrotic sndrome E3acer,ation of

)ypertension Con*esti+e ,eart failure

'n*ina1Grooks P.Am Med.1&&


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Analgesia in Labor

International

Commonl Used Pain Medications: &"ioids

@ Gind to oioid recetors2

rod$cing agonist action

that inhibits ain im$lses1

@ ,ffecti!e in se!ere ain1

@ ot associated "ith ;3

bleeding1

@ ;enerally2 no

ceiling effect

@ Serio$s risks

associated "ith oioi

side effects2

@ 7isk of tolerance and

deendency

1 5oreland W2 St. #lair ,W. The $se of analgesics in the management of ain in rhe$matic diseases. "heum !is Clin North Am. 1&&&/:1)1&1.Atcheson 72 7o"botham 4H. Pharmacology of ac$te and chronic ain. 3n: 7a"al 2 ed. Management of Acute and Chronic Pain. ondon2 ,ngland: G5H Gooks/ 1&&


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Analgesia in Labor

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Further Considerations in Prescri,ing

&"ioid 'nalgesics!45

Chronic use can lead to de#elo"ment of "hsical de"endence and tolerance

*ess a,le to control "ain on mo#ement Can "roduce $ithdra$al sndrome $ith a,ru"t cessation

Man single and com,ination o"ioid agents areshort4acting- requiring multi"le dail doses

(ncreased utili%ation of hos"ital resources

S"ecial (ssues

1es"irator de"ression

Nausea- #omiting- and consti"ation

Sedation and cogniti#e im"airment Urinar retention

Pruritus

Urticaria

'd#erse Effects

1 5oreland W et al. "heum !is Clin North Am. 1&&&/:1)1&1. Po"er 3 et al. Surg Clin North Am. 1&&&/(&:()&.Atcheson 7 et al. Management of Acute and Chronic Pain. 1&&


17/27

Analgesia in Labor

International$-'NI&$- TI$B#/N0' N0-RI

P-R&'/IN'N


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Analgesia in Labor

International


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Analgesia in Labor

International

('$P' N0-RI P-R&'/IN'N

T6) '7T(F(T'S 1'6(M )'N 7EM'8U'N PE1S'*(N'N

ontrasi tida teratur menurunmempen*aru,i lama

persalinan.

T6) 8'N(N

$en*uran*i transfer osi*en dari iu e anin.

Pola deta antun* anin anormal.


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Analgesia in Labor

International

B-RB'5'I P&I&I &''T '/' I


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Analgesia in Labor

International


22/27

Analgesia in Labor

InternationalB-RB'5'I P&I&I &''T '/' II


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Analgesia in Labor

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Analgesia in Labor

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Analgesia in Labor

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Analgesia in Labor

International

P-N('$PIN5'N P-R&'/IN'N!9 Pendam"ingan "ersalinan oleh suami da"at menurun0an

ting0at 0ecemasan secara ,erma0na " ;

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