Perbandingan Efektivitas antara Fentanyl dan Ketamine sebagai Adjuvant Epidural Analgesia dengan Ropivacaine pada Post Operasi Ekstremitas Bawah

Abstract

Background: Pain is a common complication that often occurs after surgery. Tissue and nerve damage can occur in some types of surgery such as nerve damage after lower limb surgery. epidural analgesia offers superior postoperative analgesia compared to systemic opioids. The addition of adjuvants not only increases the effectiveness of local anesthesia by prolonging and intensifying sensory blockade but also leads to a reduction in the dose of local anesthetic agents. Methods: This study is a randomized control trial, with the aim to determine the comparison of effectiveness on the use of fentanyl compared to ketamine as an epidural analgesia adjuvant. This study will select a sample size of 29 in each group based on inclusion and exclusion criteria using the double blind method. Testing of both groups is done by assessing, pain scores, hemodynamics , side effects during treatment, and Bromage scores. Results: The fentanyl group showed lower systolic, diastolic, and MAP blood pressure than ketamine, but there was no decrease in blood pressure >25% from baseline so it can be said that fentanyl provides good hemodynamic stability (p<0.05). There was a significant difference in pain scores at rest (p<0.05) but not significantly different when moving between the fentanyl and ketamine groups (p>0.05). Side effects were found more in the RK group with a total of 14 side effects with the highest incidence of side effects of blood pressure changes and pulse rate changes ranging from 20% which still provided hemodynamic stability and comfort to the patient. Meanwhile, in the fentanyl combination group there were 2 side effects with the highest incidence of side effects of nausea. There was no difference in bromage score recovery between the treatment groups (p>0.05). Conclusion: Ropivacaine-ketamine has favorable effectiveness as an analgesia adjuvant compared to ropivacaine-fentanyl.