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Analgesia in Labor
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ANALGESIA DALAM
PERSALINAN
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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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%ara &ara"olo!is
Sistei"
Anal!esia nar"oti"a
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'L(K SARAF PERIFER
'lo" ner)us pudendus
In*ltrasi perineu
Anal!esia re!ional
Epidural
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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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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$aila#le at: ttp:%%&&&.efi'.or!%eap.t(. A''essed )'to#er *1+ 2,,*.*Pillips M.JAMA. 2,,,2/4:42/-429.
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Potential Consequences of Poor
Pain Management
)ecreased motion1
0 Prolon!ed rea#ilitation
0 Mus'le atrop
0 Pneu(onia
Prolonged hospitali%ation1'&
Increased cost1'&
0 reater ospital resour'e utili3ation
Psychological impact1
Poor patient satisfaction1
1 #o$sins et al. Te%tbook of Pain. 1&&&:''()'&1. +imberg S,. Manag Care Q. --/11:')0.
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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$rchill i!ingstone/ 1&&&:''()'&1.
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Pain Sensiti%ationPain Sensiti%ation
Adated from ;ottschalk A et al.Am Fam Physician. --1/0:1&
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Pain TransmissionPain Transmission
SpinothalamicSpinothalamic
tracttractPeripheralPeripheral
nervenerve
Dorsal HornDorsal Horn
Dorsal rootDorsal root
ganglionganglion
PainPain
COX-2COX-2
COX-2COX-2
AscendingAscending
inputinput
DescendingDescending
modulationmodulation
PeripheralPeripheral
nociceptorsnociceptors
TraumaTrauma
Adated from ;ottschalk A et al.Am Fam Physician. --1/0:1&
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Treatment &"tions for 'cute andTreatment &"tions for 'cute and
Chronic PainChronic Pain
NS'()S
Nonspecific
C!"2 specific
&"ioids *ocal anesthesia
'd+uncti#e thera"
&ther
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*lufenamic Acid+efenamic Acid+eclofenamate
Klasifiasi !SA"Ds #erdasaran Strutur Kimia
Indomethacin,ulindacTolmetin
Acemethacin-idomethacin
Etodolac
Car#o$%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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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$el erosi#e disease
(nhi,ition of "latelet aggregation (ncreased ris0 of ,leeding
1e#ersi,le acute renal failure Fluid and electrolte distur,ance2edema Chronic renal failure and interstitial fi,rosis (nterstitial ne"hritis Ne"hrotic sndrome E3acer,ation of
)ypertension Con*esti+e ,eart failure
'n*ina1Grooks P.Am Med.1&&
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Commonl Used Pain Medications: &"ioids
@ Gind to oioid recetors2
rod$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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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 $ith a,ru"t cessation
Man single and com,ination o"ioid agents areshort4acting- requiring multi"le dail doses
(ncreased utili%ation of hos"ital resources
S"ecial (ssues
1es"irator de"ression
Nausea- #omiting- and consti"ation
Sedation and cogniti#e im"airment Urinar retention
Pruritus
Urticaria
'd#erse Effects
1 5oreland W et al. "heum !is Clin North Am. 1&&&/:1)1&1. Po"er 3 et al. Surg Clin North Am. 1&&&/(&:()&.Atcheson 7 et al. Management of Acute and Chronic Pain. 1&&
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P-N('$PIN5'N P-R&'/IN'N!9 Pendam"ingan "ersalinan oleh suami da"at menurun0an
ting0at 0ecemasan secara ,erma0na " ;