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Published: 2021-11-30

20-Degree Elevation to Reduce Swelling and Pain After Lower Extremity Open Reduction and Internal Fixation Surgery

Muhammad Hoesin Central General Hospital, Palembang 30126
Faculty of Nursing, Universitas Indonesia, Depok 16424
Faculty of Nursing, Universitas Indonesia, Depok 16424
elevation lower extremity open reduction and internal fixation pain swelling

Abstract

Surgery for open reduction and internal fixation (ORIF) causes tissue swelling and pain in the surgical area. Swelling and pain can be reduced by performing distal elevation in the area of surgical ORIF. This study aimed to determine the effect of a 20° elevation on swelling and pain level of patients after surgery for ORIF of the lower extremities. A quasi-experimental design with one intervention group (pretest and posttest) and one control group was implemented. Thirty-four post-operative ORIF patients treated in one hospital in South Sumatera met the inclusion criteria and were divided into intervention and control groups. Swelling circumference was measured using tape meters, and pain level was assessed with a numeric rating scale. Dependent t-test, independent t-test, and Pearson correlation were applied for data analysis. Results showed that the average difference in swelling circumference and pain level between pre and post intervention was 1.93 ± 0.25 and 1.29 ± 0.35, respectively. Significant differences were found in the mean swelling circumference and pain level between the intervention and control groups (p = 0.000). Therefore a 20° elevation of lower extremity on the second day after ORIF for two days can be an alternative for nursing intervention to reduce swelling and pain.

Abstrak

Elevasi 20 Derajat untuk Menurunkan Pembengkakan dan Nyeri Pasca Bedah Open Reduction and Internal Fixation Ekstremitas Bawah. Pembedahan open reduction and internal fixation (ORIF) menyebabkan pembengkakan jaringan dan nyeri pada area pembedahan. Pembengkakan dan nyeri dapat dikurangi dengan melakukan elevasi distal pada area bedah ORIF. Penelitian ini bertujuan untuk mengetahui pengaruh elevasi 20° terhadap tingkat pembengkakan dan nyeri pada pasien pasca operasi ORIF ekstremitas bawah. Desain kuasi-eksperimental dengan satu kelompok intervensi (pretest dan posttest) dan satu kelompok kontrol diterapkan pada penelitian ini. Tiga puluh empat pasien ORIF pasca operasi yang dirawat di salah satu rumah sakit di Sumatera Selatan memenuhi kriteria inklusi dan dibagi menjadi kelompok intervensi dan kontrol. Lingkar pembengkakan diukur menggunakan meteran pita, dan tingkat nyeri dinilai dengan skala numerik. Dependent t-test, independent t-test, dan korelasi Pearson digunakan untuk analisis data. Hasil penelitian menunjukkan bahwa rerata perbedaan lingkar bengkak dan tingkat nyeri antara sebelum dan sesudah intervensi masing-masing adalah 1,93 ± 0,25 dan 1,29 ± 0,35. Perbedaan bermakna ditemukan pada rerata lingkar pembengkakan dan tingkat nyeri antara kelompok intervensi dan kelompok kontrol (p = 0,000). Oleh karena itu, elevasi 20° ekstremitas bawah pada hari kedua setelah ORIF selama dua hari dapat menjadi alternatif intervensi keperawatan untuk mengurangi pembengkakan dan nyeri.

Kata Kunci: bengkak, ekstremitas bawah, elevasi, nyeri, open reduction and internal fixation

References

  1. Agarwal, T., Salgia, A., Biswas, S.K., Sanghi, S., & Puri, S.R. (2013). Management of closed tibial plateau fractures with percutaneous cancellous screw fixation. Medical Journal of Dr. D.Y. Patil University, 6 (1), 43–48. doi: 10.4103/0975-2870.108639.
  2. Al-Ashhab, M.E.A. (2015). “ORIF” for displaced intra-articular calcaneal fractures in children. Foot, 25 (2), 84–88. doi: 10.1016/j.foot.2015.01.004.
  3. Ayu, O. (2017). Karakteristik penderita neglected fractures yang dirawat di RSUP H. Adam Malik Medan periode Januari 2009 - Desember 2010. Majalah Kedokteran Nusantara, 47 (2), 68–71.
  4. Black, J.M., & Hawks, J.H. (2014). Medical surgical nursing (8th Ed.). Elsevier. GBD 2019 Fracture Collaborators (2021). Global, regional, and national burden of bone fractures in 204 countries and territories, 1990-2019: A systematic analysis from the Global Burden of Disease Study 2019. The Lancet Healthy Longevity, 2 (9), E580-E592. doi: 10.1016/S2666-7568(21)00172-0.
  5. Golan, D., Tashjian, A., Armstrong, E., & Armstrong, A. (2012). Principles of pharmacology: The pathophysiologic basis of drugs therapy (3rd Ed.). Lippincott Williams & Wilkins.
  6. Health Research and Development Agency of the Ministry of Health. (2019). Laporan nasional RISKESDAS 2018 [in Indonesian]. Health Research and Development Agency of the Ministry of Health Republic of Indonesia. Retrieved from https://www.litbang.kemkes.go.id/laporan-riset-kesehatan-dasar-riskesdas/
  7. Katzung, B.G., Masters, S.B., Trevor, A.J. (2012). Basic and clinical pharmacology (12th Ed.). McGraw-Hill.
  8. Kisner, C., & Colby, L.A. (2012). Therapeutic exercise: Foundation and techniques (6th Ed.). F.A. Davis Company.
  9. Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., & Bucher, L. (2011). Medical surgical nursing: Assesment and management of clinical problems (9th Ed.). Blackwell Publishing.
  10. Marik, P.E., Levitov, A., Young, A., & Andrews, L. (2013). The use of bioreactance and carotid doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodyna-mically unstable patients. Chest, 143 (2), 364–370. doi: 10.1378/chest.12-1274.
  11. Marlina, T.T. (2015). Efektivitas latihan lutut terhadap penurunan intensitas nyeri pasien osteoarthritis lutut di Yogyakarta. Jurnal Keperawatan Sriwijaya, 2 (1), 44–56.
  12. Mwaka, G., Thikra, S., & Mung'ayi, V. (2013). The prevalence of postoperative pain in the first 48 hours following day surgery at a tertiary hospital in Nairobi. African Health Sciences, 13 (3), 768–776. doi: 10.4314/ahs.v13i3.36.
  13. Ngunde, P.J., Akongnwi, A.C.N., Mefire, C.A., Puis, F., Gounou, E., Nkfusai, N.C., Nwarie, U.G., Cumber, S.N. (2019). Prevalence and pattern of lower extremity injuries due to road traffic crashes in Fako Division, Cameroon. The Pan African Medical Journal, 32, 53. doi: 10.11604/pamj.2019.32.53.17514.
  14. Oliveira, G.S.De., Agarwal, D., & Benzon, H. (2012). Perioperative single dose ketorolac to prevent. International Anesthesia Research Society, 114 (2), 424–433. doi: 10.1213/ANE.0b013e3182334d68.
  15. Pan, R., Chang, N., Chu, D., Hsu, K., Hsu, Y., Hsu, J., Tseng, L., Yang, N. (2014). Epidemiology of orthopedic fractures and other injuries among inpatients admitted due to traffic accidents: A 10-year nationwide survey in Taiwan. The Scientific World Journal, 2014, 637872. doi: 10.1155/2014/637872.
  16. Priliana, W.K., & Kardiyudiani, N.K. (2014). Pengaruh pemberian teknik relaksasi nafas dalam terhadap penurunan nyeri pada pasien paska operasi fraktur femur. Jurnal Keperawatan Notokusumo, 11 (1), 12–17.
  17. Riyadina, W., & Suhardi, P.M. (2009). Pola determinan. sosiodemografi cedera akibat kecelakaan lalu lintas di Indonesia. Majalah Kedokteran Indonesia, 59 (10), 464–472.
  18. Schnetzke, M., Swartman, B., Bonnen, I., Keil, H., Schüler, S., & Grützner, P.A. (2017). Vascular impulse technology versus elevation in the treatment of posttraumatic swelling of extremity fractures: Study protocol for a randomized controlled trial. BioMed Central, 18 (73), 1–10. doi: 10.1186/s13063-017-1824-8.
  19. Septiani, I.P. (2011). Intensitas nyeri dan perilaku nyeri pada pasien pasca bedah ORIF di rumah sakit umum pusat Haji Adam Malik
  20. Medan (Undergraduate Thesis, Universitas Sumatera Utara). Faculty of Nursing Universitas Sumatera Utara. Retrieved from http://repository.usu.ac.id/handle/123456789/24754
  21. Sharr, P.J., Mangupli, M.M., Winson, I.G., & Buckley, R.E. (2016). Current management options for displaced intra-articular calcaneal fractures: non-operative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. A contemporary review. Foot and Ankle Surgery, 22 (1), 1–8. doi: 10.1016/j.fas.2015.10.003.
  22. Sherwood, L. (2012). Human physiology: From cells to systems (8th Ed.). Cengage Learning. Singh, R., Kamal, T., Roulohamin, N., Maoharan, G., Ahmed, B., Jones, R., & Hunt, A. (2014). Ankle fractures: A literature review of current treatment methods. Open Journal of Orthopedics, 4 (11), 292–303. doi: 10.4236/ojo.2014.411046.
  23. Solomon, L., Warwick, D., Nayagam, S., & Apley A.G. (2010). Apley's system of orthopedic and fractures (9th Ed.). Hodder Arnold.
  24. Tarau, L. (2011). Nyeri kronis: Pedoman terapi untuk praktik dokter. EGC.
  25. Thomas, A.A., & Fatima, D. (2015). Pain, anxiety & functional status of patients with lower limb fracture and dislocation after open reduction. Nitte University Journal of Health Science, 5 (1), 26–30. doi: 10.1055/s-0040-1703858.
  26. Vasanad, G.H., Antin, S.M., Akkimaradi, R.C., Policepatil, P., & Naikawadi, G. (2013). Surgical management of tibial plateau fractures - A clinical study. Journal of Clinical and Diagnostic Research, 7 (12), 3128–3130. doi: 10.7860/JCDR/2013/7249.3894.
  27. Villeco, J.P. (2012). Edema: A silent but important factor. Journal of Hand Therapy, 25 (2), 153–162. doi: 10.1016/j.jht.2011.09.008.
  28. Wilkinson, J.M., & Barcus, L. (2014). Pearson nursing diagnosis handbook with NIC interventions and NOC outcomes. Pearson.
  29. Xianfeng, H., Yong, H., Penghan, Y., Lei, H., Feng, Z., & Yongping, R. (2013). The operative treatment of complex pilon fractures: A strategy of soft tissue control. Indian Journal of Orthopaedics, 47 (5), 487–492. doi: 10.4103/0019-5413.118205.

How to Cite

Purwanty, E., Maria, R., & Masfuri, M. (2021). 20-Degree Elevation to Reduce Swelling and Pain After Lower Extremity Open Reduction and Internal Fixation Surgery . Jurnal Keperawatan Indonesia, 24(3), 131–139. https://doi.org/10.7454/jki.v24i3.1000