Perbandingan Pemberian Ketamine Dosis Analgetik dan Dexmedetomidine terhadap Nyeri dengan Menggunakan Skor Critical Care Pain Observation Tool pada Pasien Paska Kraniotomi di Intensive Care Unit

Abstract

Background: Post-craniotomy pain is common with moderate to severe intensity and can lead to serious complications if not managed properly. Pain evaluation in the ICU is challenging due to limited patient communication, so CPOT is used to assess pain in non-verbal patients. The use of opioids is limited due to their side effects, so non-opioid agents such as ketamine and dexmedetomidine become alternatives. Ketamine has a strong analgesic effect, while dexmedetomidine provides sedation without depressing breathing. Objective:. This study aims to analyze the comparison of pain using the CPOT score with the administration of analgesic doses of ketamine and dexmedetomidine in post-craniotomy patients in the ICU. Methods: This study is a single blind randomized controlled trial (RCT) with a quantitative approach, aiming to compare CPOT scores in post-craniotomy patients who received analgetic doses of ketamine and dexmedetomidine in the ICU. The study was conducted in March-April 2025 at H. Adam Malik General Hospital, Hajj Hospital Medan, and TK II Rumkit Putri Hijau. Subjects were post-craniotomy patients who met the inclusion and exclusion criteria, with a total sample of 38 people (16 per group plus 20% anticipated dropout). Data were analyzed using SPSS 26.0 with t-test or Mann-Whitney test according to data distribution. Result: The baseline characteristics of the two groups were comparable (age p = 0.612; gender p = 0.749; diagnosis p = 0.856). Initial CPOT scores (T0) were not significantly different (ketamine 5.21 ± 0.88 vs dexmedetomidine 5.11 ± 0.92; p = 0.713). However, ketamine showed a greater reduction in CPOT scores at T1 (2.21 ± 0.67 vs 2.68 ± 0.82; p = 0.039), T2 (1.89 ± 0.72 vs 2.53 ± 0.68; p = 0.033), and T3 (1.68 ± 0.54 vs 2.11 ± 0.59; p = 0.041). The effectiveness of ketamine is thought to be related to the mechanism of action on NMDA receptors, making it a superior analgesic choice post craniotomy. Conclusion:. Analgesic dose ketamine is more effective than dexmedetomidine in reducing postcraniotomy pain in the ICU, with consistently lower CPOT scores up to 24 hours after administration. This effectiveness is supported by ketamine's mechanism of action as an NMDA receptor antagonist. The characteristics of patients in both groups were similar and not significantly different, so the difference in analgesic effectiveness was mainly due to the type of drug used.