DOI: https://doi.org/10.14710/jai.v0i0.57636

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: 8 Nov 2023; Published: 30 Nov 2023.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)

Citation Format:
Cover Image
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.

Note: This article has supplementary file(s).

Fulltext View|Download |  Data Analysis
Gambar dan Tabel
Subject dexmedetomidine; labor
Type Data Analysis
  Download (11MB)    Indexing metadata
 Daftar Nama dan Afiliasi Author
Author's Name
Subject
Type Daftar Nama dan Afiliasi Author
  Download (47KB)    Indexing metadata
 Permohonan Publikasi Manuskrip
Letter of Application
Subject
Type Permohonan Publikasi Manuskrip
  Download (44KB)    Indexing metadata
 Judul Manuskrip (English & Indonesia)
Title of Manuscript
Subject
Type Judul Manuskrip (English & Indonesia)
  Download (37KB)    Indexing metadata
 Statement of Author
Statement of Author
Subject
Type Statement of Author
  Download (4MB)    Indexing metadata
 Words Count & Reference Application
Words Count & Reference Application
Subject
Type Words Count & Reference Application
  Download (38KB)    Indexing metadata
 Copyright Transfer Agreement
Copyright Transfer Agreement
Subject
Type Copyright Transfer Agreement
  Download (120KB)    Indexing metadata
Keywords: analgesia; dexmedetomidine; persalinan normal; ropivacaine; sufentanil

Article Metrics:

Article Info
Section: Original Articles
Language : ID
Recent articles
Perbandingan Luaran Penggunaan Protokol Enhanced Recovery After Surgery (ERAS) dengan Perawatan Perioperatif Konvensional pada Pembedahan Umum di RSUP H. Adam Malik Medan Relationship Between Pain Severity in Post-Caesarean Section and Its Preoperative Factors Perbandingan Antara Ropivacaine-Dexmedetomidine versus Ropivacaine-Sufentanil untuk Analgesia Persalinan Normal: Tinjauan Sistematis dan Meta-Analisis Uji Acak Terkontrol Teknik Anestesia Epidural Dalam Operasi Herniotomi pada Pasien Atrial Septal Defect dengan Hipertensi Pulmonal Double Whammy Cases of Severe Mitral Stenosis in Peripartum: A Survival Case Series More recent articles
Most cited articles
Patofisiologi Penyakit Jantung Koroner Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida More cited articles
  1. Wong, C. A. Advances in labor analgesia. International Journal of Women’s Health. 2009;1(1):139. https://doi.org/10.2147/ijwh.s4553
  2. Mahisa, O., Uyun, Y., & Suryono, B. EPIDURAL LABOUR ANALGESIA (ELA). Jurnal Komplikasi Anestesi. 2016;4(1): 99–109. https://doi.org/10.22146/jka.v4i1.7278
  3. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstetrics and gynecology. 2019 Mar;133(3):e208–25. https://doi.org/10.1097/aog.0000000000003132
  4. Gao W, Wang J, Zhang Z, He H, Li H, Hou R, et al. Opioid-Free Labor Analgesia: Dexmedetomidine as an Adjuvant Combined with Ropivacaine. J Healthc Eng. 2022;2022:2235025 https://doi.org/10.1155/2022/2235025
  5. Bohringer C, Astorga C, Liu H. The Benefits of Opioid Free Anesthesia and the Precautions Necessary When Employing It. Transl Perioper Pain Med. 2020;7(1):152–7. https://doi.org/10.1155/2022/2235025
  6. Lirk P, Rathmell JP. Opioid-free anaesthesia: Con: it is too early to adopt opioid-free anaesthesia today. Eur J Anaesthesiol. 2019 Apr;36(4):250–4. https://doi.org/10.1097/eja.0000000000000965
  7. Zhi, M., Diao, Y., Liu, S., Huang, Z., Su, X., Geng, S., Shen, L., Sun, J., & Liu, Y. Sufentanil versus fentanyl for pain relief in labor involving combined spinal-epidural analgesia: a systematic review and meta-analysis of randomized controlled trials. European Journal of Clinical Pharmacology. 2020;76(4):501–506. https://doi.org/10.1007/s00228-019-02806-x
  8. Olivia Putri Chairunnisa, Ari Wahyuni. Development of Opioid-Free Anesthesia: A Literature Review. Jurnal Wawasan Kesehatan. 2022 Jul 20;1(2):22–30. https://ojs.stikara.ac.id/index.php/JWK/article/view/143
  9. Patro S. S., Deshmukh H., Ramani Y. R., Das G. Evaluation of dexmedetomidine as an adjuvant to intrathecal bupivacaine in infraumbilical surgeries. Journal of Clinical and Diagnostic Research: Journal of Clinical and Diagnostic Research. 2016;10(3):UC13–UC16. https://doi.org/10.7860/jcdr/2016/17987.7379
  10. Zhang, T., Yu, Y., Zhang, W., & Zhu, J. Comparison of dexmedetomidine and sufentanil as adjuvants to local anesthetic for epidural labor analgesia: a randomized controlled trial. Drug Design, Development and Therapy. 2019;13:1171. https://doi.org/10.2147/dddt.s197431
  11. Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., Stewart, L. A., Estarli, M., Barrera, E. S. A., Martínez-Rodríguez, R., Baladia, E., Agüero, S. D., Camacho, S., Buhring, K., Herrero-López, A., Gil-González, D. M., Altman, D. G., Booth, A., Whitlock, E. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Revista Espanola de Nutricion Humana y Dietetica. 2016;20(2): 148–160. https://doi.org/10.1186/2046-4053-4-1
  12. RoB 2: A revised Cochrane risk-of-bias tool for randomized trials | Cochrane Bias. (n.d.)
  13. Higgins, JPT. Thomas, J. Chandler, J. Cumpston, M. Li, T. Page, MJ. Welch, VA. Cochrane Handbook for Systematic Reviews of Interventions version 6.3. Cochrane. 2022 https://doi.org/10.1002/9781119536604
  14. Higgins, J. P. T., & Thompson, S. G. Quantifying heterogeneity in a meta-analysis. Statistics in Medicine. 2002;21(11):1539–1558. https://doi.org/10.1002/sim.1186
  15. Dahlan, MS. Pengantar meta analisis (edisi 2). Epidemiologi Indonesia. 2019
  16. Chen, G., Gong, M., & Liu, Y. Comparison of ropivacaine plus sufentanil and ropivacaine plus dexmedetomidine for labor epidural analgesia: A randomized controlled trial protocol. Medicine. 2020;99(36): E22113. https://doi.org/10.1097%2FMD.0000000000022113
  17. Abdalla, W., Ammar, M. A., & Tharwat, A. I. Combination of dexmedetomidine and remifentanil for labor analgesia: A double-blinded, randomized, controlled study. Saudi Journal of Anaesthesia. 2015;9(4):433–438. https://doi.org/10.4103/1658-354x.159470
  18. Li, G., Wang, H., Qi, X., Huang, X., & Li, Y. Intrathecal dexmedetomidine improves epidural labor analgesia effects: a randomized controlled trial. The Journal of International Medical Research. 2021;49(4):1–11. https://doi.org/10.1177/0300060521999534
  19. Fan, M., Li, J., Cao, R., Hu, L., & Lu, S. Efficacy and safety of dexmedetomidine-ropivacaine versus sufentanil-ropivacaine for epidural labor analgesia: a randomized controlled trial. Annals of Palliative Medicine. 2022;11(4):1410–1420. https://doi.org/10.21037/apm-22-264
  20. Li, G., Xiao, Y., Qi, X., Wang, H., Wang, X., Sun, J., Li, Y., & Li, Y. Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial. Experimental and Therapeutic Medicine. 2020;20(1):454. https://doi.org/10.3892%2Fetm.2020.8730
  21. Cheng, Q., Bi, X., Zhang, W., Lu, Y., & Tian, H. Dexmedetomidine versus sufentanil with high- or low-concentration ropivacaine for labor epidural analgesia: A randomized trial. The Journal of Obstetrics and Gynaecology Research. 2019;45(11):2193–2201. https://doi.org/10.1111/jog.14104
  22. Koltka, K., Uludag, E., Senturk, M., Yavru, A., Karadeniz, M., Sengul, T., & Ozyalcin, S. Comparison of equipotent doses of ropivacaine-fentanyl and bupivacaine-fentanyl in spinal anaesthesia for lower abdominal surgery. Anaesthesia and Intensive Care. 2009;37(6):923–928. https://doi.org/10.1177/0310057X0903700606
  23. Li, N., Hu, L., Li, C., Pan, X., & Tang, Y. Effect of Epidural Dexmedetomidine as an Adjuvant to Local Anesthetics for Labor Analgesia: A Meta-Analysis of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine. 2021. https://doi.org/10.1155/2021/4886970
  24. Lopez, M. B. Postanaesthetic shivering – from pathophysiology to prevention. Romanian Journal of Anaesthesia and Intensive Care. 2018;25(1): 73. https://doi.org/10.21454/rjaic.7518.251.xum
  25. Harimin, K., Anestesiologi dan Terapi Intensif Fakultas Kedokteran Unsri, D., Moh Hoesin Palembang Jalan Jenderal Sudirman Km, R., & Farmakologi Fakultas Kedokteran Unsri Jalan Jenderal Sudirman Km, B. Efektivitas Penambahan 2,5 µg Sufentanil pada 12,5 MG Bupivakain 0,5% Hiperbarik Terhadap Mula dan Lama Kerja Blokade Sensorik-Motorik Anestesi Spinal pada Operasi Herniorafi. 2014;46(1)
  26. Porreca, F., & Ossipov, M. H. Nausea and vomiting side effects with opioid analgesics during treatment of chronic pain: mechanisms, implications, and management options. Pain Medicine (Malden, Mass.). 2009;10(4):654–662. https://doi.org/10.1111/J.1526-4637.2009.00583.X
  27. Pang, G., Zhu, Y., Zhou, Y., & Tong, S. The Anesthetic Effect and Safety of Dexmedetomidine in Cesarean Section: A Meta-Analysis. BioMed Research International. 2022. https://doi.org/10.1155/2022/1681803
  28. Yadollahi, M., Sadegi, K., Afshari, M., & Shahraki Mojahed, B. Effect of spinal anesthesia with sufentanil on length of stages I and II of labor in singleton pregnant women: a randomized controlled trial. Universa Medicina. 2023;42(1): 94–100. https://doi.org/10.18051/UNIVMED.2023.V42.94-100
  29. Wangping, Z., & Ming, R. Optimal Dose of Epidural Dexmedetomidine Added to Ropivacaine for Epidural Labor Analgesia: A Pilot Study. Evidence-Based Complementary and Alternative Medicine, 2017. https://doi.org/10.1155/2017/7924148
  30. Grant, E. N., Tao, W., Craig, M., McIntire, D., & Leveno, K. Neuraxial analgesia effects on labor progression: facts, fallacies, uncertainties, and the future. BJOG : An International Journal of Obstetrics and Gynaecology. 2015;122(3):288. https://doi.org/10.1111/1471-0528.12966

Last update:

No citation recorded.

Last update: 2024-12-23 01:38:56

No citation recorded.