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Blok Parasternal pada Koreksi Tetrallogy of Fallot

1Laboratorium Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Mulawarman Samarinda, Indonesia

2SMF Anestesi dan Perawatan Intensif Pascabedah, Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita Jakarta, Indonesia

Published: 31 Jul 2022.
Open Access Copyright 2022 JAI (Jurnal Anestesiologi Indonesia)

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Abstract

Latar Belakang: Opioid dosis tinggi selama pembedahan jantung berhubungan dengan waktu intubasi yang memanjang dan mengakibatkan peningkatan lama perawatan, mobiditas dan tingkat mortalitas. Anestesi regional dan neuraxial telah digunakan untuk tatalaksana nyeri untuk mengurangi dosis opioid. Teknik terbaru seperti blok parasternal, pectoral dan erector spinae telah dikembangkan untuk meminimalisir komplikasi dari anestesi regional.

Kasus: Kami melakukan blok parasternal pada gadis berusia 10 tahun yang menjalani prosedur koreksi tetrallogy of fallot. Hasil laboratorium dalam batas normal. Status fisik ASA adalah 4 dengan penyakit jantung bawaan sianotik. Opioid hanya digunakan saat induksi. Injeksi bilateral dari bupivacaine 0,25% ditambah epinephrine 1:200000 dengan total volume 40 ml diberikan masing-masing 20 ml pra insisi.

Pembahasan: Hemodinamik pasien stabil selama pembedahan tanpa tanda-tanda respons terhadap nyeri. Tidak ada penambahan dosis opioid selama pembedahan. Pasien di ekstubasi pada saat pembedahan selesai.

Kesimpulan: Blok parasternal efektif sebagai adjuvan pembiusan umum pada pembedahan jantung. Teknik ini memfasilitasi penurunan dosis opioid yang membantu pasien untuk bisa di ekstubasi lebih dini.

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  1. Krakowski JC, Hallman MJ, Smeltz AM. Persistent Pain After Cardiac Surgery: Prevention and Management. Semin Cardiothorac Vasc Anesth. 2021;25(4):289–300
  2. Loskutov O, Danchyna T, Dzuba D, Druzina O. The use of multimodal low-opioid anesthesia for coronary artery bypass grafting surgery in conditions of artificial blood circulation. Kardiochirurgia i Torakochirurgia Pol. 2020;17(3):111–6
  3. Raj N. Regional anesthesia for sternotomy and bypass—Beyond the epidural. Paediatr Anaesth. 2019;29(5):519–29
  4. Cakmak M, Isik O. Transversus Thoracic Muscle Plane Block for Analgesia After Pediatric Cardiac Surgery. J Cardiothorac Vasc Anesth [Internet]. 2021;35(1):130–6. Available from: https://doi.org/10.1053/j.jvca.2020.07.053
  5. Jiang T, Ting A, Leclerc M, Calkins K, Huang J. Regional Anesthesia in Cardiac Surgery: A Review of the Literature. Cureus. 2021 Oct 16
  6. Monahan A, Guay J, Hajduk J, Suresh S. Regional Analgesia Added to General Anesthesia Compared With General Anesthesia Plus Systemic Analgesia for Cardiac Surgery in Children: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Anesth Analg. 2019 Jan 1;128(1):130–6
  7. Caruso TJ, Lawrence K, Tsui BCH. Regional anesthesia for cardiac surgery. Vol. 32, Current Opinion in Anaesthesiology. Lippincott Williams and Wilkins; 2019. p. 674–82
  8. Chen H, Song W, Wang W, Peng Y, Zhai C, Yao L, et al. Ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in mediastinal mass resection by median sternotomy: a randomized, double-blind, placebo-controlled trial. BMC Anesthesiol. 2021 Dec 1;21(1)
  9. Knight PA, Lee C. Parasternal intercostal nerve block in cardiac surgery patients Peter A . Knight , MD Parasternal Intercostal Nerve Block in Post-Cardiac Surgery Patients : A randomized , controlled trial of extended-release liposomal bupivacaine ( Exparel ® ) versus pla. 2018;1–25
  10. DoǍan Bakl E, Kavrut Ozturk N, AyoǍlu RU, Emmiler M, Karsll B, Uzel H. Effects of parasternal block on acute and chronic pain in patients undergoing coronary artery surgery. Semin Cardiothorac Vasc Anesth. 2016 Sep 1;20(3):205–12
  11. Kelava M, Alfirevic A, Bustamante S, Hargrave J, Marciniak D. Regional Anesthesia in Cardiac Surgery: An Overview of Fascial Plane Chest Wall Blocks. Anesth Analg. 2020;127–35
  12. Bedair R, Iriart X. Educational series in congenital heart disease: Tetralogy of fallot: Diagnosis to long-term follow-up. Echo Res Pract. 2019;6(1):R9–23
  13. Valente AM, Geva T. How to image repaired tetralogy of fallot. Circ Cardiovasc Imaging. 2017;10(5):1–12
  14. Hayes-Lattin M, Salmi D. Educational Case: Tetralogy of Fallot and a Review of the Most Common Forms of Congenital Heart Disease. Acad Pathol. 2020;7
  15. Eva Miranda Marwali, Yoel Purnama, Poppy Surwianti Roebiono. Modalitas Deteksi Dini Penyakit Jantung Bawaan di Pelayanan Kesehatan Primer. J Indones Med Assoc. 2021;71(2):100–9
  16. Ellouze O, Missaoui A, Berthoud V. Parasternal pectoral block for right anterior minimally invasive thoracotomy in cardiac surgery Conflict of Interest : Source of Funding Statement : Acknowledgements : Author ’ s contributions : Introduction : J Cardiothorac Vasc Anesth. 2020;34(2):450–3
  17. Sepolvere G, Fusco P, Tedesco M, Scimia P. Bilateral ultrasound-guided parasternal block for postoperative analgesia in cardiac surgery: Could it be the safest strategy? Reg Anesth Pain Med. 2020;45(4):316–7

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