• Mashdarul Maarif
• Sarma N. L. Lumbanraja
• Iman Helmi Effendi
• Edwin Martin Asroel
• Yudha Sudewo

The rate of delivery by cesarean method is increasing worldwide and exceeds the recommended range limit of the World Health Organization (WHO) by 10-15%. Based on the Basic Health Research (Riskesdas 2018), the prevalence of cesarean delivery was 17.6%, where the highest was found in the Special Capital Region of Jakarta (31.3%) and the lowest was in Papua (6.7%). This research is a randomized controlled clinical trial (randomized clinical trial) with a one group posttest design. The sampling location was in Sundari Medan Hospital. The study sample was all pregnant women who gave birth in the operating room and met the research criteria. The sample was divided into 2 groups, namely the group given a single dose of opioid oral analgesic agent (tramadol) 50 mg and the group that was given a single dose of oral analgesic agent NSAID (mefenamic acid) ) 500 mg at 12 hours post cesarean section selected randomly then assessed pain intensity as assessed by Visual Analog Scale. Samples were obtained by consecutive sampling.22 The minimum sample in each group is 25 subjects.The number of samples was 50 people in which 25 subjects were divided into group A (given a single dose of oral analgesic agent NSAID / mefenamic acid) and 25 subjects in group B (given a single dose of oral analgesic agent opioid / tramadol) at 12 hours post cesarean section. The following are the characteristics of the age and parity of the study sample.Postoperative analgesia comparable to opioids has been demonstrated with non-steroidal anti-inflammatory drugs (NSAIDS). The µ-opioidergic and monoaminergic pathways (5-hydroxytryptamine and noradrenaline) and individual prostaglandin-dependent mechanisms are important in pain modulation. By inhibiting the cyclooxygenase enzyme and preventing central and peripheral synthesis of prostaglandins, NSAIDs reduce the inflammatory component of pain formation and also effectively relieve pain of uterine contractions in the postpartum period and after cesarean delivery.23 Tramadol is a centrally acting analgesic and is structurally related to codeine and morphine, consisting of two enantiomers, both of which contribute to their analgesic activity via different mechanisms. Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAID). It's most commonly used to treat dysmenorrhea pain in the short term (seven days or less), as well as mild to moderate pain including headaches, toothaches, postoperative and postpartum pain.24 In general, paracetamol and ordinary NSAIDs in short-term use are safe and levels in milk are low. Ibuprofen (600-800 mg orally every 8 hours) has the best documented safety, followed by mefenamic acid (most commonly prescribed in our environment) and ketorolac. The use of specific COX2 inhibitors such as celecoxib and parecoxib also showed no signs of harm. The use of naproxen and indomethacin, however, is less recommended.25

Tramadol, Mefenamic Acid, Post Caesarean

"THE MEAN PAIN INTENSITY DIFFERENCE OF TRAMADOL ANALGESICS WITH MEFENAMIC ACID ON THE VAS VALUE IN POST-CESAREAN SECTION PATIENTS", International Journal of Emerging Technologies and Innovative Research (www.jetir.org), ISSN:2349-5162, Vol.7, Issue 10, page no.941-950, October-2020, Available :http://www.jetir.org/papers/JETIR2010124.pdf

"THE MEAN PAIN INTENSITY DIFFERENCE OF TRAMADOL ANALGESICS WITH MEFENAMIC ACID ON THE VAS VALUE IN POST-CESAREAN SECTION PATIENTS", International Journal of Emerging Technologies and Innovative Research (www.jetir.org | UGC and issn Approved), ISSN:2349-5162, Vol.7, Issue 10, page no. pp941-950, October-2020, Available at : http://www.jetir.org/papers/JETIR2010124.pdf