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Perbandingan Antara Ropivacaine-Dexmedetomidine versus Ropivacaine-Sufentanil untuk Analgesia Persalinan Normal: Tinjauan Sistematis dan Meta-Analisis Uji Acak Terkontrol

1Fakultas Kedokteran, Universitas Pelita Harapan, Tangerang, Indonesia

2Fakultas Kedokteran, Universitas Katolik Atma Jaya, Jakarta, Indonesia

3Departemen Anestesiologi, Universitas Pelita Harapan, Tangerang/ Siloam Hospital Lippo Village, Tangerang, Banten, Indonesia

Received: 28 Aug 2023; Revised: 4 Nov 2023; Accepted: 11 Nov 2023; Available online: 30 Nov 2023; Published: 8 Nov 2023.

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Abstract

Latar Belakang: Persalinan seringkali berhubungan dengan nyeri yang dikatakan menjadi rasa nyeri paling hebat yang dialami oleh banyak perempuan semasa hidupnya. Obat yang umum digunakan bersama anestesi lokal untuk blok neuroaksial pada persalinan adalah opioid, namun diperlukan perhatian mengingat efek samping yang tidak diinginkan. Dexmedetomidine dapat menjadi salah satu alternatif dengan efek samping minimal.

Tujuan: Untuk membandingkan profil analgesia, karakteristik persalinan, dan efek samping dari dexmedetomidine versus sufentanil sebagai kombinasi dengan ropivacaine pada persalinan normal.

Metode: Berdasarkan protokol preferred reporting items for systematic review and meta-analysis (PRISMA) 2015, penelitian diambil dari PubMed, Science Direct, PubMed Central (2018-21 Juli 2023) menggunakan kata kunci medical subject headings (MeSH) “dexmedetomidine” dan “labor”. Kriteria inklusi yaitu penelitian yang membandingkan kombinasi ropivacaine-dexmedetomidine dan ropivacaine-sufentanil sebagai obat analgesik untuk persalinan normal. Kami mengeksklusi penelitian selain uji acak terkontrol. Kami mengukur risiko bias menggunakan RoB 2.0 dan Cochrane Review Manager 5.4 untuk menganalisis data. Mean differences (MD) digunakan untuk hasil numerik dan odds ratio (OR) untuk hasil kategorik.

Hasil: Enam uji acak terkontrol (543 subjek) memenuhi kriteria inklusi. Tidak ada perbedaan signifikan pada profil analgesia, keluaran neonatus, dan durasi persalinan antara dua kelompok. Grup dexmedetomidine mempunyai peluang pruritus dan menggigil lebih rendah dibanding grup sufentanil (OR = 0,11, 95% IK = 0,02 - 0,60, p = 0,01), (OR = 0,23, 95% IK = 0,06 - 0,96, p = 0,04). Di sisi lain, kami menemukan tidak adanya perbedaan pada mual dan muntah antara keduanya. Semua studi memiliki risiko bias rendah dan funnel plot yang menunjukkan distribusi yang simetris.

Kesimpulan: Ropivacaine-dexmedetomidine dan ropivacaine-sufentanil memiliki hasil yang serupa untuk profil analgesia dan karakteristik persalinan, namun dexmedetomidine memiliki efek samping yang lebih sedikit, terutama untuk pruritus dan menggigil.

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Keywords: analgesia; dexmedetomidine; persalinan normal; ropivacaine; sufentanil

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