Perbandingan kualitas anestesi Lidokain 1 persen dan Lidokain 3 persen Hiperbarik pada Spinal Anestesi

SIMARMATA, Sahat Marudut M, dr. Pandit Sarosa Hadi, SpAn.K

2004 | Tesis | PPDS I Anestesiologi dan Reanimasi

Tujuan Membandingkan kualitas anestesia pada anestesi spinal dengan Lidokain 1% hiperbarik dengan lidokain 3% hiperbarik. Desain Randomized Controlled Clinical trial dengan pembutaan ganda Ruang lingkup Penderita yang akan menjalani operasi terencana di Instalasi Bedah Sentral Terpadu RS DR Sardjito Yogyakarta dengan anestesi blok spinal Subyek Enam puluh dua pasien laki-laki dan perempuan, usia 17-70 tahun, berat badan 40–70 kg, tinggi badan 150-170 cm, status fisik sesuai klas ASA I–II, operasi elektif pada daerah : perineum, anggota gerak bagian bawah, minor urology dengan lama pembedahan kurang dari 60 menit Intervensi Subyek dibagi menjadi dua kelompok yang terdiri dari 31 orang, yang semuanya menjalani operasi dengan anestesi spinal.Kelompok A mendapat injeksi 3 ml lidokain 1% hiperbarik dan Kelompok B mendapat 1 ml Lidokain 3% hiperbarik . Seluruh pasien mendapat cairan prabeban 16 ml/kgBB kristaloid (RL) sebelum spinal anestesi Pengukuran utama Parameter-parameter yang diukur adalah : onset sensorik dan motorik, regresi sensorik 2, 4 segmen, regresi sampai S2, regresi motorik sampai Bromage O Hasil Kelompok A : Mula analgesi 14,71 ± 4,73; mula motorik 5,42 ± 1,88; tingkat analgesi maksimal 8,42 ± 0,99; t regresi 2 segmen 54,52 ± 7,34; t regresi 4 segmen 83,20 ± 9,00 ; t regresi sampai S2 103,87 ± 17,64; tregresi motorik sampai Bromage O 57,10 ± 16,77. Kelompok B : Mula analgesi 13,13 ± 2,86; mula motorik 3,16 ± 2,86; tinggi analgesi (thorakal) 8,58 ± 0,81; t regresi 2 segmen 52,58 ± 9,21; t regresi 4 segmen 79,62 ± 10,36; t regresi sampai S2 98,06 ± 11,67; t regresi motorik sampai Bromage O 69,68 ± 14,26. Secara statistik tidak ada perbedaan bermakna pada blok sensorik maupun tinggi analgesi ( p > 0,05) sedangkan blok motorik secara statistik ada perbedaan bermakna (p < 0,05) Kesimpulan Kualitas anestesi spinal dengan 1 ml lidokain 3% hiperbarik lebih baik dari pada 3 ml lidokain 1% hiperbarik dalam mula motorik lebih cepat dan durasi motorik lebih lama

Objective To compare anesthesia of quality of spinal anesthesia between hyperbaric lidocaine 1% and 3% Design A double blind randomized clinical trial Setting Patients scheduled operation and performed spinal anesthesia at Sardjito General hospital, Yogyakarta Subject Sixty-two adult male and female patients, age 17-70 years old, weight 40-70 kg, height 150-170 cm, physical status according to class ASA I–II, were scheduled for elective perineum area, lower extremity, minor urologic surgery and durations of all surgical procedures less than 60 min. Intervention Subjects were distributed randomly into two groups (A) and (B), consist of 31 patients. They were scheduled for spinal anesthesia. Group A (3 ml lidocaine hyperbaric 1% ) and group B ( 1ml lidocaine hyperbaric 3% ). All patients received 16 ml/kg of lactate ringer’s solution intavenously before the spinal anesthesia. Main outcome measurement Measured parameters were sensoric and motoric onset; 2, 4 segments regression, complete regression of S2 and motor regression until bromage 0 . Result Group A; sensoric block : onset : 14,71 ± 4,73; 2 segment regression 54,52 ± 7,34 ; 4 segment regression 83,20 ± 9 ; S2 regression 103,87 ± 17,64 ; highest sensoric level block 8,42 ± 0,99. Motoric block : onset : 5,42 ± 1,88 ; motoric regression until Bromage 0 : 67,10 ± 16,77 . Group B : sensoric block: onset : 13,13 ± 2,86; 2 segment regression 52,58 ± 9,21; 4 segment regression 79,62 ± 10,36 ; S2 regression 98,06 ± 11,67 ; highest sensory level block 8,58 ± 0,81. Motoric block; onset : 3,16 ± 2,86 ; motoric regression until bromage 0 : 69,68 ± 14,26. There were no statistical differences observed at onset, duration and highest sensoric level block between two groups (p > 0,05). However, there were significant difference observed at motor blocked and regression until Bromage 0 (p< 0,05). Conclusion The quality of spinal anesthesia with 1 ml lidocaine hyperbaric 3% is better than 3 ml lidocaine hyperbaric 1% especially in faster onset and longer duration of motoric blocked

Kata Kunci : Anestesi Spinal,Pharmakokinetik,Lidokain 1 Persen dan 3 Persen, spinal anesthesia, quality of spinal anesthesia, hyperbaric lidocaine