Perbandingan Efektivitas Anestesi Spinal Menggunakan Bupivakain Hiperbarik dengan Bupivakain Isobarik pada Pasien yang Menjalani Prosedur Operasi Abdomen Bagian Bawah di RSUP Dr. Kariadi

*Taufik Eko Nugroho  -  Department of Anesthesiology and Intensive Theraphy; Faculty of Medicine; Diponegoro University; Semarang, Indonesia
Jati Listiyanto Pujo  -  Department of Anesthesiology and Intensive Theraphy; Faculty of Medicine; Diponegoro University; Semarang, Indonesia
Herning Tyas Pusparini  -  Department of Anesthesiology and Intensive Theraphy; Faculty of Medicine; Diponegoro University; Semarang, Indonesia
Published: 1 Nov 2019.
DOI: https://doi.org/10.14710/jai.v11i3.25387 View
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Abstract

Latar Belakang: Lebih dari 300 juta prosedur bedah dilakukan di seluruh dunia setiap tahun. Sekitar 5% atau 15 juta prosedur bedah dilakukan dengan teknik anestesi spinal. Bupivakain hidroklorida adalah anestesi lokal aminoasil dan merupakan anestesi lokal yang paling umum digunakan. Ada dua jenis bupivakain yang digunakan yaitu hiperbarik dan isobarik. Perbedaan kepadatan dari dua jenis obat ini diyakini mempengaruhi pola difusi obat tersebut dan dengan demikian menentukan efektivitas, hemodinamik, penyebaran blok, dan efek samping obat.

Tujuan: Membandingkan efektivitas bupivakain hiperbarik dengan bupivakain isobarik pada pasien yang menjalani operasi abdomen bagian bawah.

Metode: Penelitian ini menggunakan metode single blind randomized controlled trial dengan consecutive sampling. Ethical Clearance diperoleh dan pasien memberikan ketersediaan dalam penelitian dalam lembar informed consent. Sebanyak 48 pasien yang menjalani prosedur operasi elektif ASA I-II abdomen bagian bawah di RSUP Dr. Kariadi yang sesuai dengan kriteria inklusi. Dibagi menjadi 2 kelompok; kelompok I mendapatkan bupivakain hiperbarik 0.5% 15 mg dan kelompok II mendapatkan bupivakain isobarik 0.5% 15 mg. Posisi kedua pasien saat dilakukan spinal dalam posisi duduk. Tusukan dilakukan di L3-4. Setelah dilakukan anestesi spinal pasien diposisikan tidur terlentang dengan bantal. Dilakukan pencatatan status hemodinamik, pencatatan ketinggian blok menggunakan tes tusuk (pinprick), dan tes bromage, serta pencatatan efek samping pada menit ke 1, 3, 6, 9, 12, 15, dan 30. Keseluruhan data dianalisis menggunakan uji Mann-Whitney.

Hasil: Onset dari bupivakain hiperbarik lebih cepat daripada bupivakain isobarik (2,00 ± 0.18 menit versus 5,13 ± 0,34 menit, p < 0,001). Durasi kelompok isobarik lebih panjang dibandingkan hiperbarik (180 + 22 menit versus 150 + 24 menit, p < 0.001). Ketinggian blok sensoris dan motorik tidak berbeda bermakna (p>0,05). Untuk ketinggian blok sensoris titik tertinggi adalah T5 pada kelompok I dan kelompok II dicapai pada menit ke 6. Untuk ketinggian blok motorik titik tertinggi adalah T5 pada kelompok I yang dicapai pada menit ke 6, sedangkan pada kelompok II dicapai pada menit ke 9. Efek samping berupa mual dan muntah lebih tinggi pada kelompok hiperbarik (p<0,05).

Kesimpulan: Bupivakain isobarik tidak lebih efektif dibandingkan bupivakain hiperbarik pada pasien yang akan menjalani prosedur operasi perut bagian bawah.

Note: This article has supplementary file(s).

Keywords: abdomen bagian bawah; anestesi spinal; anestesi regional; barisitas; bupivakain

Article Metrics:

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