NYERI

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2/16/13

Pengelolaan Nyeri
IASP

(the international Association For the Study of Pain) : perasaan atau pengalaman tidak menyenangkan yang dihubungkan dengan kerusakan jaringan atau potensial terjadi kerusakan Persepsi terhadap nyeri:

derajat kerusakan jaringan latar belakang budaya pengalaman terhadap nyeri sebelumnya rasa takut dan tidak berdaya

2/16/13

Perception

Pain Perception
Medulation

Pai n

Descending modulation Ascending input

Dorsal Horn

Dorsal root ganglion

Conduction

Spinothala mic tract

Transmission

Periphe ral nerve

Transductio n
Trau ma

Peripher al nocicept ors Adapted from Gottschalk A et al. Am Fam Physician. 2001;63:1981, and Kehlet H et al. Anesth Analg. 1993;77:1049.

Modified by AHT 2/16/13

Classification of Peripheral nerve

2/16/13

Nociceptors;is
characterized by their response;

1. A-delta Mechanothermal nociceptors

q q q q

Respond to mechanical and thermal stimuli. display rapid conduction. Produced first pain and well localized. Ad fibers respond to this naciceptors.

2. C-fiber Polimodal nociceptors

q q

Respond to mechanical, thermal and chemical. Slow conduction. 2/16/13

Pain Rating Scales

10

Mild

Moderate

Severe

Pain threshold Pain tolerance

Choosing pain killer and its combinations

10 Pain Intensity Scale

10

Mild

Moderate

Severe
Strong opioid NSAID adjuvant analgesic
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paracetamo NSAID l or/+ weak opioid NSAID adjuvant adjuvant analgesic analgesic

Providing Pain Relief

Perception

Modulation

Transmission

Transduction

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Multimodal Analgesia
PERCEPTI ON
Pai n OPIOID - Systemic - Epidural - Subarachnoid Ketamin, Tramadol, agonist COX-2, COX-3?

LOCAL ANESTHETIC MODULATI Descending ON - Epidural Dorsal modulation Horn -Subarachnoid Ascending CONDUCTIO input -Peripheral N/ TRANSNISSI nerve block Ster ON oids Spinothalami Periphe c LA TRANSDUCTI ral tract TRANSMISSI nerve ON COXON Trau 1 ma Peripher al COXnocicept No single drug can produce optimal analgesia without adverse effect ors 2 Modified by AHT 2/16/13
Adapted from Gottschalk A et al. Am Fam Physician. 2001;63:1981, and Kehlet H et al. Anesth Analg. 1993;77:1049.

More GI side effects

Acetosal Ketorolac

COX-1 selectiv e inhibitor

analgesic

Less GI side effects

Indomethaci Ibuprofen Diclofenac Celecoxib n Ketoprofen Meloxicam Rofecoxib Piroxicam Nimesulide Valdecoxib

COXIB

preferentiall y COX-1 selective inhibitor

anti-inflammatory

nonselectiv e COX inhibitor

preferentiall y COX-2 selective inhibitor

COX-2 selectiv e inhibitor

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