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Erwin Kresnoadi
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an unpleasant sensory and emotional
experience associated with actual
or potential tissue damage or
described in term of such damage.
Nyeri adalah rasa indrawi dan
pengalaman emosional yang tidak
menyenangkan akibat adanya
kerusakan jaringan yang nyata atau
yang berpotensi rusak, atau
tergambarkan seperti itu.
DEFINISI NYERI
A Definition
of Pain

by John D.Loeser, M.D.
IASP (International Association for the Study of Pain) 1979 defined pain as :
H. Merskey
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NYERI
Akut
Kronis
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Nyeri yang terjadi akibat adanya
kerusakan jaringan yang nyata.
(Pain with injury)
NYERI AKUT
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PENYEBAB
Inflamasi / Kerusakan Jaringan
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MEKANISME NYERI
TRANSDUKSI
TRANSMISI
MODULASI
PERSEPSI
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TRANSDUKSI
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TRANSMISI
Action Potential
Electrical basis for signal
transmission within a nerve
cell.

Cell depolarizes due to a
change in internal ion
concentration.

Depolarization travels down
the axon away from cell
body.
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MODULASI
Afferent Central
Terminal
Glutamate
Sub P
Activity
NK1
mGluR
NMDA
AMPA
VGCC
GABA
A
Adensosine
Opiate
CB1
Dorsal Horn
Neuron
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PERIPHERAL SENSITIZATION
Innocuous/Noxious
stimulus
primary sensory neuron central neuron
Primary hyperalgesia
Primary allodynia
Inflammation
Reduced Transduction Threshold
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CENTRAL SENSITIZATION
Noxious
stimulus
primary sensory neuron central neuron
Secondary hyperalgesia
Tactile allodynia
Irritants
Tissue damage
Inflammation
Increased Pain Responsiveness
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Descending pain pathway (Purves, 2001).
PERSEPSI
Modulation of
Pain Perception
The Descending Pain Pathway
The Periaqueductal Grey is the
major convergence point.
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PERCEPTION
MODULATION
TRANSMISSION
TRANSDUCTION
OPIOID
- Systemic
- Epidural
- Subarachnoid
LOCAL ANESTHETIC
- Epidural
- Subarachnoid
NSAIDs
PENGELOLAAN NYERI
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TARGET OF PAIN THERAPIES
Gottschalk et al., 2001
Alternative methods
Acupuncture
Physical Therapy
Chiropractics
Surgery
Pharmacotherapy
Non-opioid analgesics
Opioid analgesics
Nerve Blocks
Adjuvant analgesics (neurophatic,
musculoskeletal)
NSAID
Electrical Stimulation
Transcutaneous electrical nerve
stimulation (TENS)
Percutaneous electrical nerve
stimulation (PENS)
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PERAN NSAIDs
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Normal Tissue Inflammation Site
Physiolgical
Prostaglandin
Production
Pathological
Prostaglandin
Production
COX-1
Constitutive
COX-2
Inducible
Arachidonic Acid
Normal Functions Inflammation, pain, fever
NSAIDs
COX-2
Inhibitors
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Cytokines
Growth factors
Treatment pain cheklist
Understand the pain pathway
Understand the proposed procedure
Understand possible pain treatment options
Review previous records of pain treatment
Identify contraindications to treatments
Review the impact of coexisting disease
processes
Discuss options with the patient
Discuss options with the surgeon
Considere the risk/benefits for each option
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Recommendations Grade A :
NSAID are not sufficiently effective as the sole
agent after major surgery in most patients
But are often effective after minor to moderate
surgery
NSAID decrease opiod requirement ( decrease side
effect of opioid)
Quality of opiod analgesia is often enhance by
NSAID
In situation where there are no contraindications,
NSAID are the drug of choice after many day case
procedure
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1. Nyeri akut diobati secepat mungkin.
2. Pada nyeri berat, perlu kombinasi :
NSAID
Opiat
3. Perlu pendekatan psikologi.
KESIMPULAN
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A close relationship between the
surgeon & anesthesiologist