Mengenal Nyeri Neuropatik Akut Pasca Seksio Sesarea
Abstract
Nyeri neuropatik akut pascabedah Seksio Sesarea (SS) ditandai dengan adanya tanda dan gejala nyeri neuropatik yang berbeda dari nyeri nosiseptif berupa alodinia dan hiperalgesia, yang ditemukan pada periode awal hingga 1 bulan pascabedah. Nyeri neuropatik akut dapat terjadi akibat cedera langsung pada saraf iliohipogastrika dan ilionguinal akibat pembedahan SS, yang selanjutnya memicu pelepasan ektopik dan perubahan kanal ion pada saraf perifer, serta memicu terjadinya sensitisasi sentral. Meskipun demikian, disfungsi saraf pascabedah biasanya merupakan kombinasi dengan nyeri nosiseptif akibat kerusakan jaringan dan peradangan. Skrining perioperatif dan faktor risiko dapat menggunakan alat skrining Douleur Neuropathique en 4 (DN4) atau DN2 untuk mencegah perkembangan menjadi nyeri persisten. Pendekatan saat ini untuk pencegahan nyeri neuropatik kronis bertujuan untuk mengoptimalkan analgesia dan mengurangi nosisepsi dari nyeri akut dengan memodifikasi teknik bedah dan memilih anestesi regional. Pengobatan nyeri neuropatik memerlukan kombinasi terapi farmakologis, fisik, dan terapi perilaku. Beberapa terapi lini pertama pada penanganan nyeri neuropati akut seperti gabapentinoid, opioid, antagonis reseptor NMDA, hingga terapi stimulasi listrik transkutan dan stimulasi medula spinalis menjadi pertimbangan untuk nyeri neuropatik akut.
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