Volume 3, No. 5 May
2024 (574-585)
p-ISSN 2980-4868 |
e-ISSN 2980-4841
https://ajesh.ph/index.php/gp
Effectiveness
of the Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for Postoperative
Pain Management in Patients Undergoing Major Surgical Operations at Manokwari Hospital
Christan Chaputtra Maharibe
Universitas Sam Ratulangi,
Manado, North Sulawesi, Indonesia
Email: christanmaharibe@gmail.com
ABSTRACT
Postoperative pain
is a common complication in patients undergoing major surgical operations,
interfering with comfort and recovery and increasing the risk of further
complications. This study aimed to evaluate the effectiveness of NSAIDs in
managing postoperative pain at Manokwari Regional
Hospital. Utilizing qualitative research methods, data was collected through
observation and literature study and analyzed via data reduction, data
presentation, and conclusion drawing. The findings indicate that NSAIDs
effectively alleviate postoperative pain by inhibiting cyclooxygenase (COX)
enzymes responsible for prostaglandin production. However, their use is limited
by potential systemic side effects, including gastrointestinal disorders,
kidney impairment, increased blood pressure, heart attack, and heart failure.
Consequently, topical NSAID formulations are recommended to mitigate these
risks. The study suggests that while NSAIDs are effective, clinicians should
consider their side effects and prefer topical alternatives. Future research
should explore the efficacy and safety of topical NSAIDs and alternative pain
management strategies to enhance clinical practice.
Keywords: Anti-Inflammatory Drugs, Pain Management,
Postoperative, Major Surgery.
INTRODUCTION
Pain
is a significant public health issue worldwide, with chronic pain affecting
approximately 27% of the adult population in Europe and more than 100 million
adults in the United States. Acute pain that is not treated properly can
increase the risk of various health problems. The impact includes delayed wound
healing, decreased immune function, cardiovascular problems associated with the
stress response, and respiratory problems such as pneumonia. In addition,
severe, unresolved chronic pain can have far-reaching negative impacts on a
person's quality of life, daily functioning, sleep quality, interpersonal
relationships, and work productivity. In addition, chronic pain is also
associated with a large economic burden on individuals and society as a whole
Postoperative
pain is one of the complications that often occur in patients undergoing major
surgical operations. These painful sensations disturb the patient's comfort and
can hinder their overall recovery process. Therefore, postoperative pain
management is an important aspect of the care of major surgical patients to
ensure optimal recovery and reduce the risk of postoperative complications. A
wide variety of pain medications have been used to manage postoperative pain,
including nonsteroidal anti-inflammatory drugs (NSAIDs).
NSAIDs
are one of the most commonly prescribed drugs both in
Indonesia and in other countries. The use of NSAIDs often lasts for a long
period of time because these drugs are used to relieve symptoms of inflammation
in chronic conditions such as osteoarthritis and rheumatoid arthritis. Although
NSAIDs provide benefits in reducing symptoms of inflammation, the mechanism of
action can also interfere with the defense of the digestive tract mucosa
Previous research by
The
novelty of this study is from the research subjects, namely patients undergoing
major surgical operations at Manokwari Hospital,
which have never been studied before. The results
of this study can be the foundation for further research in deepening
understanding of the mechanism of action, appropriate dosage, and potential
side effects of using NSAIDs in the context of postoperative pain management. The purpose of this study was to evaluate the effectiveness
of the use of NSAIDs in the management of postoperative pain in patients
undergoing major surgical operations at Manokwari
Regional Hospital.
RESEARCH METHODS
This
study used qualitative research methods. A qualitative research method is a
method of research that emphasizes analysis or description. In a qualitative
research process, subjects' perspectives are highlighted, and the basis of
theory is established so that the research process is in accordance with the
facts encountered in the field. Qualitative research methods aim to explain a
phenomenon in depth and are carried out by collecting more detailed data
RESULTS AND
DISCUSSION
Surgery or surgery is a
general term in medicine that refers to a medical process that involves
physical intervention on a person's body. The types of surgery are divided into
two main categories: minor surgery, which consists of minor or uncomplicated procedures,
and major surgery, which includes larger, more complex procedures. Minor surgery involves intervening in a limited part of the
body, while major surgery involves the body's organs as a
whole. The risk of complications tends to be lower in minor surgery
compared to major surgery. Most patients undergoing minor surgical procedures can
usually go home the same day
Surgery is performed for various
purposes, including diagnosing disease, treating injury or disability, and
treating medical conditions that are difficult or cannot be overcome by
medication alone. Major surgery includes various procedures such as gallbladder
removal (cholecystectomy), kidney removal (nephrectomy), making openings in the
intestine (colostomy), removal of the uterus (hysterectomy), breast removal
(mastectomy), limb amputation, surgery due to trauma, abdominal opening
(laparotomy), and Caesarea procedure (cesarean section) to deliver a baby
It was recorded that in
2018, major surgical procedures in Indonesia reached a significant level. One
such type of procedure, laparotomy, ranked fifth in the number of cases. Of the
total 1.2 million surgeries performed, it is estimated that about 42% of them
are laparotomy. According to data from the
Indonesian Ministry of Health in 2018, surgery ranks eleventh out of 50
diseases treated in hospitals throughout Indonesia, with a percentage of around
12.8%. About 32% of these surgeries are estimated to be laparotomy. Then, the
rate of major surgery in Indonesia is very high, with about 75% of cases
performed; the procedure involves various surgical specialties, including
digestive, pediatric, oncology, plastic, thorax, vascular, orthopedics, and
urology. More than 60% of these cases are related to digestive surgery, while
the rest are evenly distributed in cases from other surgical specialties
Major surgery has become
part of medical services in various hospitals throughout Indonesia, including
at RSUD Manokwari. RSUD Manokwari
is a type C regional general hospital located in Manokwari
Regency, Papua. Manokwari Hospital provides various medical
and health services to the local community. Major
surgery is a major surgical procedure generally performed using general or
general anesthesia. This type of surgery involves comprehensive intervention
and is often performed in an inpatient surgical unit
Major surgery involves
the use of general anesthesia to remove the patient's consciousness during the
procedure so that they do not feel pain. In medical terms, major surgery can be
considered as major surgery that requires general anesthesia. According to
EU-IACUC standards, major surgery includes surgical procedures that penetrate
and expose entire body cavities, including the skull and bone dissection, or
result in significant damage to anatomy or bodily functions. Major surgery
involves head, neck, chest, and abdomen interventions. Typically, major surgery
involves one of the three major cavities of the body: the abdomen (laparotomy),
chest (thoracotomy), or skull (craniotomy), and can also include vital organs
General anesthesia is
necessary for major surgical procedures such as laparotomy
because it involves opening the abdomen by making incisions in the layers of
the abdominal wall to access organs within it that may have problems such as
bleeding, perforation, cancer, or obstruction. This action is generally
performed for conditions such as perforated appendicitis, inguinal hernia,
stomach, colon, rectal, intestinal obstruction, chronic colitis, cholecystitis,
and peritonitis
Major surgeries have
proven effective in treating serious injuries, disabilities, and medical
conditions that are difficult to treat with other methods. However, the side
effects of surgical procedures are often in the form of pain that can be
experienced by the patient. The surgical process involves invasive procedures
that require the opening or appearance of the part of the body to be operated
on by making an incision. This can cause discomfort for patients due to trauma
that occurs in body tissues during the operation process, which then leads to
pain sensations
1. Median
incision, which is performed in the middle of the abdomen and is used for
abdominal surgery involving large areas inside the abdomen.
2.
Paramedian incision (to the right) is usually used for cases
such as appendix masses or surgery on other specific areas
to the right of the abdomen.
3.
Pararectal incision is an incision made around the rectal
area and used for surgery related to surrounding organs.
4.
McBurney's incision is performed in an area known as
McBurney's point, which is to the lower right of the abdomen and is often used
for appendectomy surgery (removal of the appendix).
5.
Pfannenstiel incision, which is an incision in the lower
area of the abdomen, near the pubic hairline, and is often used for surgery on
the bladder or uterus.
6.
A transverse incision, which is a horizontal incision in the
abdomen can be used for various types of surgery depending on the need.
7.
Subcostal (right) incision, which is an incision under the
right rib cage and is often used for surgeries such as cholecystectomy (removal
of the gallbladder).
During the surgical
process and as a result of the incision, patients
often experience pain or tenderness. The intensity, duration, and frequency of
postoperative pain can vary from patient to patient. The pain felt by
postoperative patients is caused by mechanical irritation of the surgical wound,
which triggers the release of chemical mediators that stimulate pain perception
in the body
Although postoperative
pain is a natural physiological reaction, it is one of the complaints that
worries patients the most. The painful sensation begins to be felt before the
patient has completely recovered from the anesthesia, and the intensity increases
as the effect of the anesthetic decreases. It is important to manage pain
because comfort is a basic human need. Discomfort due to pain can affect a
person's daily activities and quality of rest
According to research, as
many as 46% of patients who undergo major surgery experience chronic pain
afterward. This percentage far exceeds the prevalence of chronic pain reported
in adult populations in other developing regions
The alternative applied
to reduce pain at Manokwari Hospital after major
surgery is to give Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). NSAIDs are
drugs that are often prescribed by doctors and are freely available in the
community. The mechanism of action of NSAIDs mainly involves the inhibition of cyclooxygenase
(COX) enzyme activity. The enzyme COX has a key role in the production of
prostaglandins, which are the main mediators of pain sensation. The effectiveness of NSAIDs is based on their ability to
inhibit prostaglandin synthesis through inhibition of cyclooxygenase enzyme
action. The cyclooxygenase enzyme works in the conversion pathway of
arachidonic acid into prostaglandins and thromboxane. When these enzymes are
inhibited by NSAIDs, this conversion process is disrupted, resulting in reduced
prostaglandin production. As a result, the pain response of the tissue affected
by surgery is reduced
The cyclooxygenase enzyme
(COX) is a protein that facilitates the chemical reaction that converts
arachidonic acid into prostaglandins. Prostaglandins are important molecules
involved in various physiological processes in the body, such as regulating inflammatory
responses, responding to pain, regulating protective secretions of the stomach
lining, maintaining blood flow to the kidneys, and regulating platelet
aggregation in blood clotting
The pain that appears after surgery is often
caused by the stimulation of the nociceptor, which is a receptor sensitive to
stimuli that can cause pain. Opioids, such as morphine, are one type of drug
that is often used to manage postoperative pain. Opioids work by activating
opioid receptors scattered in different parts of the brain so that nociceptive
signals are centrally blocked, reducing pain perception. However, opioid use is not always ideal because it has the
potential to cause side effects such as dependence, respiratory depression, and
constipation. Therefore, the administration of NSAIDs has been considered
effective in the management of postoperative pain, especially for major
surgery. The use of NSAIDs is on the rise due to concerns about side effects
associated with opioid use
At Manokwari
Hospital, NSAIDs commonly used for pain management after major surgery are in
the form of oral drugs such as Paracetamol, Diclofenac Sodium, and ibuprofen.
In addition, if more intensive treatment is needed, intravenous administration
can be done with drugs such as ketorolac or acetaminophen (paracetamol). The
dose of intravenous acetaminophen is usually adjusted to the patient's weight,
with about 15 mg/kg body weight or 1 gram if the patient's body weight is more
than 50 kg.
Based on observations in
patients undergoing major surgery at Manokwari
Regional Hospital, the administration of Non-Steroidal Anti-Inflammatory Drugs
(NSAIDs) proved to be very useful as a single analgesic after surgery. NSAIDs
help reduce pain by a different mechanism than opioids and, therefore, may be a
safer or preferred option for some patients. Although
NSAIDs bring significant benefits in pain management, their use is sometimes
limited by the risk of possible systemic side effects. These side effects
include disorders of the gastrointestinal tract, such as damage to the
gastrointestinal mucosa, as well as problems such as constipation and renal
dysfunction. In addition, non-selective use of NSAIDs can also be associated
with an increased risk of cardiovascular events, such as hypertension, stroke, and
heart attack, and can even cause death
So, to prevent side effects or other
potentially dangerous negative impacts for patients, it is essential to adhere
to the basic principles in the use of painkillers. The use of the drug is
considered appropriate if the patient receives it according to his clinical
needs, in adjusted doses, with appropriate duration of use, and at a reasonable
cost. Meanwhile, in addition to using NSAIDs in oral
and parenteral (intravenous) forms, Manokwari
Regional Hospital also uses additional approaches in topical form. One example
of topical NSAIDs used at Manokwari Hospital is
Sodium Diclofenac Topical, which aims to reduce pain at the surgical incision
site. Using NSAIDs in topical form, the drug can be applied directly to
the area of pain so that it can provide an analgesic effect locally with a
smaller amount of medication compared to oral or parenteral use. This can
reduce the risk of systemic side effects associated with the use of NSAIDs
The use of NSAIDs in
topical form is a safer option and is preferred in pain management. This is
because topical formulations can provide effective analgesic effects with a
lower risk of side effects. However, it is important to ensure that such
topical formulations are used according to the doctor's instructions, and the
patient must be properly informed about how they are used. Therefore, it is advisable to improve the understanding of
medical staff at Manokwari Hospital regarding the
administration of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the
management of major postoperative pain due to varying pain preferences and
patient risks.
CONCLUSION
The
application of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) has proven
effective in reducing postoperative pain in patients undergoing major surgical
procedures at Manokwari Regional Hospital. The
mechanism of action of NSAIDs is by inhibiting the activity of cyclooxygenase
(COX) enzymes, which have an important role in producing prostaglandins that
trigger pain sensations. Although NSAIDs bring significant benefits in pain
management, their use is sometimes limited by the risk of systemic side effects.
These side effects include disorders of the digestive tract, decreased kidney
function, increased blood pressure, risk of heart attack, and even heart
failure. Therefore, to reduce the risk of these side effects, the use of NSAID
formula in topical form is a preferred alternative.
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