dr. I Putu - Acute Pain Service Denpasar
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Transcript of dr. I Putu - Acute Pain Service Denpasar
CURRICULUM VITAENama : dr. I Putu Pramana Suarjaya, SpAn, KMN, KNATempat/Tanggal Lahir : Denpasar, 8 Juni 1969Alamat : Jalan Tukad Yeh Penet 11A, Renon, DenpasarIstri : dr. Ni Made Puspa Dewi AstawaAnak-anak : I Putu Krisna Murti Made Kartika Dewi Nyoman Ira Sayani Saraswati I KetutAgama : Hindu Riwayat Pendidikan SD 3 Saraswati Denpasar 1976-1982SMP N 3 Denpasar 1982-1985SMAN 1 Denpasar 1985-1988Fakultas Kedokteran Universitas Udayana Denpasar 1988-1995Pendidikan Dokter Spesialis Anestesi 1999-2003Fakultas Kedokteran Universitas Padjadjaran, BandungPendidikan Magister Kesehatan 2001-2003 Fakultas Kedokteran Universitas Padjadjaran, Bandung7. Pendidikan Konsultan NeuroAnesthesia dan Neuro Critical Care 2009-2012 Kolegium Anestesiologi dan Terapi Intensif, Fakultas Kedokteran Universitas Padjadjaran, Bandung
Pendidikan TambahanDalam Negeri
ESPEN LLL (Bali, 2012)
LuarNegeri Asia Pasific Parenteral Nutrition Workshop (Kuala Lumpur 2010) Medical Observership di Department of Anesthesiology and Intensive Care, Tan Tock Seng Hospital, Singapore (Singapore 2011)Pengalaman KerjaDokter di kapal MV. Illiria, (1996)Dokter PTT di Puskesmas Ubud I, Gianyar Bali (1996-1999)Dokter Asisten di Bagian Anestesiologi RS Sanglah, Denpasar Bali (1999)Dokter Spesialis Anestesi RS Zainul Abidin, Banda Aceh (2004)Dokter Spesialis Anestesi RS Korpri Puri Raharja Denpasar (2004- sekarang) Dokter Spesialis Anestesi RS Sanglah Denpasar (2004-sekarang)Keanggotaan Profesi
Ikatan Dokter Spesialis Anestesiologi Indonesia ( IDSAI) BaliIndonesian Society of Anesthesiology for Pain Management (ISAPM)Perhimpunan Manajemen Nyeri Indonesia (PMNI)Indonesian Society of Neuro Anesthesia and Critical Care ( ISNACC)Asian Society of Neuro Anesthesia and Critical Care (ASNACC)Anggota IDI Wilayah BaliAnggota IDI DenpasarAnggota PKDGI
ACUTE PAIN SERVICE
in DENPASAR I Putu Pramana Suarjaya
IGN Mahaalit Aribawa
Department of Anesthesiology and Intensive CareSanglah General Hospital
Denpasar
1. Pulse 2. Blood
pressure3. Temperature4. Respiratory
rate
05/02/2023BROS 4
Pain:The Fifth
Vital Sign™
*by now health care professional asses patient for pain every time we check for other vital sign
June 2005
Anesthesiology-Based APS• Introduced in US, 1988
Nurse-Based APS• Introduced in Sweden, 1991
The Organization Structure of APS
• ANESTHESIA RESIDENT BASE
Developed in teaching hospital
Non teaching -Private Hospital
APS IN DENPASAR
Despite of advanced knowledge & techniques in acute pain management
Postoperative pain
MORE than 50% patients do not receive adequate postoperative pain relief
Filos,KS: lehman, KA, Eur Surg Des 2002
1.Confusion about who is responsible for postoperative pain management ?
2.Inadequate knowledge of analgesics (opioid & non-opioid analgesics).
3.Administration of analgesic is too late, when the patient complain of pain.
4.Using single modality and similar to every surgery.
Why postop pain continue to be undermanaged ?
1.PATIENT BARRIERS :
• ANXIETY AND PAIN
2. PROFESSIONAL BARRIERS
• ATTITUDE : UNWILLINGNESS TO RAISE THE PRIORITY OF PAIN• LACK OF ASSESMENT AND DOCUMENTATION• LACK OF KNOWLEDGE ABOUT PAIN AND PAIN KILLER
BARRIER TO APS
3. ORGANISATIONAL BARRIERS
• ACCOUNTABILITY WHO??• LOCAL POLICIES RULES AND REGULATION??• LOCAL RESOURCES• GLOBAL BARRIERS AND NATIONAL POLICIES
BARRIER TO APS……..
MULTIMODAL ANALGESIA
IV kontinyu : syringe pump
Oral analgesia
Epidural analgesia :
intermitten dan kontinyu
Intratekal opioid
MULTIMODAL Bolus IV
Patch percutaneus
Peripheral Nerve Block : continuous
Patient Controlled Analgesia ( PCA) : IV and
Epidural
12
GRANDFATHER OF PCA….
13
PCA + TCI
PCA PORTABLE
15
PERBANDINGAN PCA IV : IM : BOLUS IV
APS IN PRIVATE HOSPITAL ( BALI ROYAL HOSPITAL / BROS )
1. PATIENT BARRIERS
• PATIENT’S REQUEST PAIN FREE HIGHER SOCIAL CLASS
SOME BARRIERS RESOLVE
2. PROFESIONAL BARRIERS :
• SURGEON LACK OF PAIN AWARENESS BUT WILLING TO SET PAIN FREE FOR PATIENT CONSULT TO ANESTHETIS
• ASSESMENT AND DOCUMENTATION START AS PART OF MED RECORD
• NURSE GET CONTINUING PAIN UP GRADE SESSION
AT BROS HOSPITAL…………
ACCOUNTABILITY WHO?
• ANESTHETIS RESPONSIBLE FOR PAIN MANAGEMENT, MIN 3 DAYS
LOCAL POLICIES RULES AND REGULATION
• DEVELOPMENT AND IMPLEMENTATION OF SOP• SET UP PAIN MANAGEMENT TEAM INCL NURSE & GP ON DUTY • ANESTHETIS CONSULTANT VISITE DAILY & READY 24 H
3. ORGANISATIONAL BARRIERS
AT BROS HOSPITAL…………
LOCAL RESOURCES • MEDICAL STAFF TRAINING @ 1 MONTH• PAIN MANAGEMENT EQUIPMENT SUPPLY:
• SYRINGE PUMP BY HOSPITAL• PERIPHERAL BLOCK CATHETER• PATIENT CONTROLLED ANALGESIA MACHINE : 11 PCA MACHINE
IN BROS HOSPITAL (BY ANESTHETIS)• USG (BY ANESTHETIS)
GLOBAL BARRIERS AND NATIONAL POLICIES COMMON PROBLEM
ORGANISATIONAL BARRIERS……..
AT BROS HOSPITAL…………
JAN FEB MRT APR MEI JUN JUL AUG SEP OKT0.00%
10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%
PCAEPIDURALSYRINGE PUMP
ANALGESIA METHODE BROS HOSPITAL 2012
SYRINGE PUMP; 63.29%
PCA; 18.50%
EPIDURAL; 5.78%
BOLUS IV / ORAL; 10.72%
PERIPHERAL BLOCK; 2.00%
SYRINGE PUMPPCAEPIDURALBOLUS IV / ORALPERIPHERAL BLOCK
PAIN MANAGEMENT MODALITY JANUARY-OCTOBER 2012 BROS HOSPITAL
BARRIERS TO APS NOT YET CLEARED JCI ACRREDITATION ENCOURAGE
APS IN TEACHING HOSPITAL-RS SANGLAH DENPASAR
1. PATIENT BARRIER
• WIDE PATIENT VARIETY• PATIENT LESS DEMANDING
2. PROFESIONAL BARRIER
• OPERATOR STILL UNWILLINGNES TO TREAT PAIN• ASSESMENT & DOCUMENTATION ONLY DONE BY ANESTHETIST AND NURSE,
SURGEON DO NOT
ORGANISATIONAL BARRIERS
• SOP• IF VAS <5 SURGEON RESPONSIBLE FOR PAIN MANAGEMENT POST OP• IF VAS ≥ 5 ANESTHETIST RESPONSIBLE• RULES DAN REGULATION NOT WELL ESTABLISHED YET• LACK OF HOSPITAL UNDERSTANDING OF PAIN MANAGEMENT MODALITY
BANNED NEW TECHNIQUE BY MANAGEMENT• EQUIPMENT SUPPLY FOR PAIN MANAGEMENT
ANALGESIA MODALITY RS SANGLAH
STARTING MAY 2012, DRIP NOT USED ANYMORE JCI
SISTEMIC IV :1.SYRINGE
PUMP2.PCA
PATIENT CONTROLLED ANALGESIA
CONTINOUS INFUSION
EPIDURAL ANALGESIA
CONTINUOUS SUPRACLAVICULAR BLOCK
CONTINUOUS SCIATIC BLOCK
“DUAL EPIDURAL THORAKAL-LUMBAL CONTINUOUS
PATIENT CONTROLLED ANALGESIA
POST THORAKOTOMY + FR CLAVICULA BY PCA
CONT. INFRACLAVICULAR BLOCK
CONTINUOUS FEMORAL BLOCK
CONTINUOUS INTERSCALENI BLOCK
THANK YOU
05/02/2023 38
BULAN PEMAKAIAN PCA
TOTAL PASIEN OPERASI
PERSENTASE PEMAKAIAN
JANUARI 11 108 10.18FEBRUARI 14 108 12.96MARET 15 161 9.3APRIL 19 133 14.28MEI 24 175 13.71JUNI 21 172 12.20JULI 19 133 14.29AGUSTUS 37 147 25.17SEPTEMBER 48 158 30.38OKTOBER 64 160 40TOTAL 272 1455 18.69
PEMAKAIAN PCA DI BROS 2012
PEMAKAIAN EPIDURAL BROS 2012
BULAN PEMAKAIAN EPIDURAL
TOTAL PASIEN OPERASI
PERSENTASE PEMAKAIAN
JANUARI 6 108 5.55FEBRUARI 5 108 4.63MARET 8 161 4.96APRIL 10 133 7.51MEI 9 175 5.14JUNI 8 172 4.65JULI 7 133 5.26AGUSTUS 11 147 7.48SEPTEMBER 12 158 7.59OKTOBER 9 160 5.62TOTAL 85 1455 5.84
PEMAKAIAN SYRINGE PUMP DI BROS 2012
BULAN PEMAKAIAN S.P.
PCA EPIDURAL
ORAL-BOLUS IV
BLOK PERIFER
TOTAL PASIEN OPERASI
PERSENTASE PEMAKAIAN SP
JANUARI
87 11 6 10 4 108 82.07
FEBRUARI
74 14 5 11 4 108 68.51
MARET 116 15 8 19 3 161 72.04APRIL 87 19 10 15 2 133 65.41MEI 119 24 9 20 2 175 68JUNI 122 21 8 18 3 172 70.93JULI 93 19 7 12 2 133 69.92AGUSTUS
82 37 11 14 3 147 55.78
SEPTEMBER
80 48 12 15 3 158 50.63
OKTOBER
61 64 9 22 4 160 38.12
921 272 85 156 (10.72)
30 (2.06%)
1455 63.29