The Relationship Of Anti-Inflammation Non Steroid Use Patterns With Side Effects In Patients Post Appendectomy At Jemursari Islamic Hospital

ABSTRACT


Introduction
Appendicitis is a condition where there is acute inflammation of the vermiform appendix caused by bacterial infection, tumors of the appendix, and worms which can cause blockages to form in the lumen (Diantari et al., 2018).The presence of these blockages can cause more mucus production and a decrease in the elasticity of the appendix wall and a feeling of pain occurs (Flum, 2015).
In Indonesia, appendicitis patients account for around 27% of the population (Kemenkes, 2018).In 2017 in East Java, there were 5,980 cases of appendicitis and 177 of them died (Dinkes Jatim, 2017).
Appendectomy is a surgical procedure or surgical removal of the appendix by opening the abdomen.Almost all patients feel pain after surgery (Zulfikar et al., 2015).
The analgesic used in post appendectomy patients is to use nonsteroidal anti-inflammatory drugs (NSAIDs) (Baumann and Strickland, 2014).
Inadequate pain management in postappendectomy patients can have side effects (drug related problems) in patients (Handayani et al., 2019).Univariate data analysis used a frequency distribution with a percentage size for categorical data and numerical data used the mean or average value.Bivariate data analysis using Chi-Square or Fisher's exact test with a significance level of 5% (P <0.05).

b. Drug dose
Administering a therapeutic dose for 3 days is the minimum duration of therapy that can relieve pain in postoperative patients.Using drugs for a long time or too fast can interfere with the mechanism of action of the drug so that it can cause side effects (Tejovathin et al., 2017).
In this study Ketorolac at a dose of 30 mg was associated with hypotension, whereas a dose of 90 mg was associated with Related Problems (DRP) are unwanted events experienced by the patient concerned that are related to drug therapy, this can disturb achievement of therapeutic goals.According to Michele's research (2015) DRP is a case that can cause patient mortality and morbidity.Methods This type of research is descriptive analytic withcross-sectional design.The population of this study were all postappendectomy patients who received post operative analgesic therapy in 2019-2020 as many as 143 and the sample used was 62 research subjects.The sampling technique uses the technique non-random sampling by taking samples purposive sampling.
Acid 500mg related with side effects of nausea (p<0.05) and has a weak correlation value of 0.343 or <0.5 in the Cramer's V test.b.Ketorolac 30 mg is associated with side effects of hypotension (p<0.05) and has a weak correlation value of 0.389 or <0.5 in the Cramer's V test.c.Ketorolac 90 mg is associated with side effects of headache (p<0.05) and has a weak correlation value of 0.429 or <0.5 in the Cramer's V test.d.Santagesic 500 mg is associated with side effects of dyspepsia (p<0.05) and has a weak correlation value of 0.400 or <0.5 in the Cramer's V test.Based on Table7, it is informed that the use of NSAIDs at less doses is associated with side effects of hypotension (p<0.05) and the value of strong relationship is 0.598 or >0.5 on the Cramer's V test.Based onTable 8, it is informed that the types of drugs associated with side effectsare: a.The duration of 4 days of therapy is associated with side effects of nausea (p<0.05) and has a weak correlation value of 0.325 or <0.5 in the Cramer's V test.b.The duration of 4 days of therapy is associated with side effects of vomiting (p<0.05) and has a weak correlation value of 0.395 or <0.5 in the Cramer's V test.c.The duration of 5 days of therapy is associated with side effects of constipation (p<0.05) and has a strong correlation value of 0.701 or >0.5 in the Cramer's V test.d.The duration of therapy of 5 days is associated with side effects of dyspepsia (p<0.05) and has a strong correlation value of 0.558 or >0.5 in the Cramer's V test.Non-opioid analgesics widely used in post-appendectomy patients are nonsteroidal anti-inflammatory drugs (NSAIDs) and can cause side effects in their use.Drug side effects are unwanted events that occur in patients related to drug therapy (Luke et al., 2017).Using analgesics nonopioid (NSAIDs) that are widely used in post-appendectomy patients are NSAIDs which work to prevent the formation of prostaglandins in response to impulses thereby reducing the number of pain impulses received by the CNS.NSAIDs are lipophilic and acidic, so they can cause damage topically, while the systemic effects of NSAIDs are caused by mucosal damage that occurs due to decreased prostaglandin production.Decreased production of prostaglandins can also cause damage to the stomach and duodenum (Baumann & Strickland, 2014).In this study the types of drugs associated with side effects were the use of Mefenamic Acid 500 mg with side effects of nausea, Ketorolac 30 mg with side effects of hypotension, Ketorolac 90 mg with side effects of headache, Santagesic 500 mg with side effects of dyspepsia and had a weak relationship strength (<0.5).The administration of Mefenamic Acid 500 mg, Ketorolac 30 mg, Ketorolac 90 mg and Santagesic 500 mg therapy causes side effects with weak relationship because basically every administration of therapy will always cause unexpected side effects.All drugs in this class is NSAID drugs that work by inhibiting prostaglandins and COX inhibitors.Mefenamic acid is a class of NSAID drugs that are COX non-selectively that works to inhibit pain stimuli in organs that secrete cyclooxygenase enzymes (Kresnadi drug works by inhibiting the synthesis of prostaglandins in the peripheral and central nervous systems(Gunawan, 2016).This study agrees with previous research by Ida cahyati et al., (2019) that the use of NSAIDs such as Santagesic often causes dyspeptic side effects.The mechanism of dyspepsia occurs due to inhibition of prostaglandin synthesis which causes reduced resistance of the gastric mucosa (Amrulloh & Utami, 2016).In this study, the use of NSAIDs at low doses was associated with side effects of hypotension and had a strong relationship (>0.5).NSAIDs that use less doses are Antrain 500 mg (5 respondents) and Santagesic 500 mg (1 respondent) which are given to respondents aged 12-15 years.These side effects arise due to the inappropriate use of NSAIDs in the selection of doses.Selection of the less dose will be cause unexpected drug reactions, especially in children, because the body's response to drugs is not as good as that of adults.The results of this study stated that the administration of NSAIDs with a duration of therapy of 4 days was associated with side effects of nausea and vomiting.While the duration of therapy of 5 days is associated with side effects of constipation and dyspepsia and has a strong relationship (>0.5).NSAIDs are prostaglandin inhibitors and COX inhibitors, so the longer the therapy is given, the stronger it will cause digestive tract disorders.This research agrees with previous research conducted by Amrulloh & Utami, (2016) and Idacahyatiet al., (2019) that the longer the administration of NSAID therapy increases the incidence of nausea, vomiting, constipation and even dyspepsia.Conclusion 1.The pattern of use of non-steroidal anti inflammatory analgesics in post appendectomy patients at Jemursari Surabaya Hospital in 2019-2020 is: a.Most of the NSAIDs used were ketorolac 30 mg (58.1%).

Table 1 .
Characteristics of NSAID drug types

Table 2 .
Accuracy of NSAID Dosage c. Length of therapy

Table 3 .
Duration of NSAID Therapy

Table 4 .
Number of Respondents

Table 5 .
Description of the side effects of NSAIDs

Table 6 .
The relationship of NSAID Drug Types with Drug Side Effects (Drug Related Problems)

Table 7 .
The relationship of NSAID Drug Doses with Drug Side Effects (Drug Related Problems)

Table 8
The relationship between NSAID therapy duration and drug side effects *Description: Numbers with bold is significant (p<0.05)