Introduction: This study aims to present the management of postoperative c-section pain using multimodal analgesia. Case presentation: There were two patients who received multimodal analgesia as a treatment for postoperative C-section pain. The first patient, a woman 15 years old, will undergo a Caesarean section operation with indications G1P0A0, term pregnancy, and cephalopelvic disproportion (CPD). The second patient, a 23-year-old woman, will undergo a Caesarean section operation with indications G1P0A0, term pregnancy, and 1x umbilical cord. Physical examination of both patients showed vital signs within normal limits. Laboratory evaluation within normal limits. Both patients were included in the ASA II category. The anesthetic method used intraoperatively was subarachnoid block with hyperbaric bupivacaine 0.5% 10 mg and morphine 50 mcg. Lidocaine infiltration injection is performed intraoperatively in combination with the following; lidocaine 2% (3 ampoules), dexamethasone 4 mg, ketorolac 60 mg, and morphine 4000 mcg dissolved in aquabides into 20 ml subcutaneously. Conclusion: A multimodal analgesia is an appropriate approach for postoperative pain management in patients undergoing cesarean section.

AbstrakFentanyl patch dapat digunakan untuk manajemen nyeri pascabedah. Tujuan penelitian ini membandingkan efektivitas kombinasi fentanyl patch 12,5 µg/jam dan 25 µg/jam dengan ketorolak 30 mg intravena pada pascabedah ortopedi ekstremitas bawah dengan anestesi spinal. Penelitian ini merupakan uji klinis acak tersamar ganda pada 24 pasien dengan status fisik American Society of Anesthesiologist (ASA) I dan II, usia 18-50 tahun yang menjalani operasi ortopedi ekstremitas bawah di kamar operasi bedah sentral Rumah Sakit H. Adam Malik dan rumah sakit jejaring pada bulan Oktober-November 2015. Pasien dibagi menjadi dua kelompok, yaitu 12 orang menerima fentanyl patch 12,5 µg/jam (A) dan 12 orang menerima fentanyl patch 25 µg/jam (B) ditempelkan ±2 jam sebelum pembedahan dan dikombinasi dengan ketorolak 30 mg intravena yang diberikan saat dimulainya insisi. Penilaian skala nyeri dilakukan menggunakan nilai visual analog scale (VAS). Data hasil penelitian diuji dengan uji chi-square. Hasil perhitungan statistika didapatkan kombinasi kelompok fentanyl patch 25 µg/jam bermakna lebih efektif dibanding dengan kelompok fentanyl patch 12,5 µg/jam (p<0,05). Simpulan penelitian ini adalah secara klinis perbedaan nilai VAS kedua kelompok tidak berbeda. Kata Kunci:Efek samping, fentanyl patch, ketorolak, visual analog score (VAS) AbstractFentanyl patch is the first injection-free system for post surgery pain management that is a safe, easy to use, and comfortable modality for patient. The aim of this study was to differentiate the effectiveness and side effect of 12.5 µg/hour and 25 µg/hour fentanyl patch combinations with 30 mg intravenous ketorolac after orthopedic surgery of lower extremity under spinal anesthetic. This was a double random clinical trial for 24 patients with physical status American Society of Anesthesiologist (ASA) I and II, 18-50 years old of age, who underwent orthopedic extremity surgery in the operating theaters of H. Adam Malik Hospital and other hospitals in October-November 2015. Patients were divided into two groups, i.e. 12 patients received 12.5 µg/hour fentanyl patch (A) and 12 patients received 25 µg/hour fentanyl patch (B) for ±2 hours before surgery, combined with 30 mg intravenous ketorolac given at the start of incision. The pain was scored using a visual analog scale. Data were then statistically analyzed using chi-square test. The result of the study showed that the use of 25 µg/hour fentanyl patch was significantly more effective than the 12.5 µg/ hour fentanyl patch (p<0.05). It is concluded that the clinical VAS scores for the two groups after orthopedic surgery of lower extremity are different.