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CURRICULUM VITAENama : dr. Andi M. Takdir Musba, Sp.AnTempat, Tanggal Lahir : Pare-Pare, 31 Oktober 1974Pangkat / Golongan : Penata Muda Tk I / III-dAlamat rumah : JL. Datuk Ditiro II No. 15 Makassar 90214, IndonesiaTelp / Hp : 0411-452113 / 0811463304Email : [email protected] kantor : Bagian Ilmu Anestesi, Perawatan Intensif & Manajemen Nyeri
Fakultas Kedokteran UNHAS / RS. Dr. Wahidin Sudirohusodo Jl. Perintis Kemerdekaan Km.11 Tamalanrea Makassar-90245
Telp/HP/Fax/Email : 0411-582583-589777 /Fax. 0411-590290 / [email protected]
Riwayat Pendidikan :- Dokter Umum tahun 1999 Fakultas Kedokteran Universitas Hasanuddin- Spesialis Ilmu Anestesi tahun 2007 Fakultas Kedokteran Universitas HasanuddinPelatihan / Kursus :- Tahun 2003 : Kursus Perioperative, Surabaya, Indonesia- April 2006 : Pain Management Workshop and Refresher Course, Makassar- November 2006 : Acupuncture and TCM Workshop, Makassar oleh Fakultas Kedokteran
Universitas Hasanuddin dan Xiamen University, China- Februari - April 2008 : Course on Clinical Pain Management Program, Siriraj Hospital,
Mahidol University, Bangkok, Thailand- Maret 2008 : Interventional Pain Management Workshop, Bangkok
IMPLEMENTATION OF ACUTE PAIN SERVICES IN HOSPITAL
A.M.TAKDIR MUSBA
Department of Anesthesiology, Intensive Care and Pain Management Faculty of Medicine, Hasanuddin University
ACUTE PAIN MANAGEMENT
“ Acute Pain is defined as pain of sudden onset that is often severe “
SAFE AND EFFECTIVE MANAGEMENT IS A BASIC REQUIREMENT OF ANY PROFESSIONAL HEALTH SERVICES
The Royal College of Anaesthetist, 2010
THE NEED OF APS
HOSPITAL MEDICAL PPROFESSIONAL PATIENTS
PATIENTS PERSPECTIVE HUMANITARIAN AVOIDANCE CONSEQUENCES OF UNTREATED
SEVERE PAIN REDUCE THE RISK OF CHRONIC PAIN PRESERVATION ORGAN FUNCTION AND FAST-
TRACK RECOVERY
THE GOALS OF ACUTE PAIN SERVICE
The objectives of APS is an organization dedicated to the management of acute pain of surgical, non-surgical patient or other patient with acute pain
MODEL OF APS ORGANIZATION
ANESTHESIOLOGIST BASED, NURSE SUPPORTED
NURSE BASED, ANESTHESIOLOGIST-LED
DEPEND ON : LOCAL PATIENTS PROFILE LOCAL CONDITION RESPONSIBILITIES FOR CARE OF SURGICAL AND
MEDICAL PATIENTS
APS ORGANIZATION : AN EXAMPLE
WHY ANESTHESIOLOGIST ?
Familiar with pharmacology of all analgesia Aware of the short and long-term effect of
drugs given intra-operatively Knowledgeable about pain pathway and
their interruption Skilled in technique needed to pain control (PCA or EA or PNB).
Anesthesiologists are a logical choice to provide pain relief in the immediate postoperative period, since they are:
Acute pain management is not the responsibility of pain specialist but a concept which need to embraces by all anaesthesiologist
S.A.Schug Chairman, SIG acute Pain IASP
In Anesthesia and Intensive Care, Vol.39,2011
PERATURAN MENTERI KESEHATAN REPUBLIK INDONESIANOMOR 519/MENKES/PER/III/2011
TENTANGPEDOMAN PENYELENGGARAAN PELAYANAN ANESTESIOLOGI DAN
TERAPI INTENSIF DI RUMAH SAKIT
Menanggulangi masalah nyeri akut di rumah sakit (nyeri akibat pembedahan, trauma, maupun nyeri persalinan).
HOPE NOT TO BE JUST A RHETORIC …
INITIATING ACUTE PAIN SERVICE (1) SUPPORT :
HOSPITAL MANAGERS ANESTHESIA DEPARTMENT Other MEDICAL PROFESIONAL
APPROPRIATE SELECTION OF ANALGESIC REGIMEN
STANDARDIZED PROTOCOLS AND GUIDELINE EDUCATION AND TRAINING TRIAL ON ONE WARD ONLY BEFORE WHOLE
HOSPITAL AUDIT AND QUALITY IMPROVEMENT
INITIATING ACUTE PAIN SERVICE (2)
Conclusion : Move away from invasive and less targeted analgesic
modalities has not compromised the quality of analgesia provided.
Major morbidity remains extremely rare Incidence of complications has been reduced over the
years.Patient satisfaction remains well in excess of 90 percent,
and the side effects are largely well controlled. Advancements in the provision of acute postoperative
analgesia, the APS will continue to play an important role in the holistic convalescence of the surgical patient.
Singapore Med J, 2008, 49(12)
All public hospital in HK57% of patients received iv PCA , 32% EA. Duration of APS treatment was 3.1 days.Anaesthesiologist-based acute pain
services take care of a limited number of patients should be a move towards an anaesthesiologist-led, pain nurse–based APS
APS METHODS OF POSTOPERATIVE PAIN RELIEF Two standard methods of postoperative pain
relief in APS1. Epidural Analgesia (EA) 2. Patient-Controlled analgesia
(PCA) Continuous peripheral nerve block Intrathecal opioid NSAIDs (COX-1 & COX-2)
BENEFIT OF EA : MAKE IT REAL TO SURGEON excellent analgesia less sedation earlier ambulation decreased incidence of pulmonary
complications decreased incidence of venous thrombosis earlier return of bowel function decreased stress response
OUR KNOWLEDGE AND SKILL Indication Contraindication Technique and appropriate placement catheter Agent used : availability, routes, Pk/Pd
Epidural technique as analgesia for postoperative pain
relief
REGIMEN EPIDURAL COMBINATIONCommon opioids concentration Common LA concentration
Morphine 10 mcg/mlHydromorphone 10mcg/mlFentanyl 2-5mcg/mlMeperidine 2mg/ml
Common infusion rate : 5 – 14 cc / hr
Bupivacaine 0.1% (1mg/ml).Bupivacaine 0.05% (0.5mg/ml)Ropivacaine 0.2% (2mg/ml)
Siriraj hospital APSBupivacaine 0.0625% + Morphine 0.01 – 0.02 mg/mlInfusion rate 3 -6 ml/hr
Wahidin Hospital APS1. Bupivacaine or Levo-bupivacaine 0.1 - 0.125 % + Pethidine 20 mg
or Fentanyl 20 mcg Intermittent bolus each 4-6 hr2. Bupivacaine or Levo-bupivacaine 0.1 – 0.125 % + Fentanyl 2
mcg/ml infusion rate 4 – 6 ml / hr
APS PATIENT RECORD
GUIDELINES AND PROTOCOL Side effect and the management Troubleshooting for inadequate analgesia
STAFF ( MEDICAL AND NURSE ) WITHIN AND AFTER HOURS EDUCATION FOR THEM APPROPRIATE MONITORING OF PATIENTS
MEDICAL AND NURSE EDUCATION
“ make pain visible “
PROVISION APPROPRIATE DRUGS AND EQUIPMENT
KASUS MENURUT DIVISI BEDAH, APRIL 2004 – DESEMBER 2009
Bagian n %Digestif 871 30.77Obgyn 836 29.53
Ortopedi 379 13.40Urologi 625 22.08Thorax 70 2.48tumor 21 0.74Plastik 28 0.99
Jumlah 2832 100
AUDIT AND QUALITY IMPROVEMENT
KASUS SESUAI PEMBEDAHANN=2823,2004-2009
Digesti
fObg
yn
Ortope
di
Urolog
i
Thora
xtum
or
Plasti
k 0.00
10.00
20.00
30.00
40.0030.77 29.53
13.40
22.08
2.48 0.74 0.99
%
%
INTENSITAS NYERI ( NRS ) N=2823,2004-2009
0 1 - 3 4 - 6 7 - 100.00
10.0020.0030.0040.0050.0060.0070.0080.0090.00
15.88
81.39
2.73 0.00
Persentase tingkat nyeri
Persentase tingkat nyeri
DIAGRAM TINGKAT KEPUASAN N=2823,2004-2009
tidak puas
kurang puas
puas sangat puas
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
0.005.96
79.40
14.62
persentasi tingkat kepuasaan
APS : The Chance for Anaesthesiology“Anaesthesiologist now have a golden opportunity to expand their services into a field where we easily can get many satisfied customers, something very different from the operating room or the intensive care unit, where our patients are asleep or too sick to appreciate our efforts.”
(Breivik. Pain Digest 1993;3:27)
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