Perbandingan Efektivitas Anestesi Spinal menggunakan Levobupivacaine isobarik 0.5% 7,5 mg dengan Levobupivacaine 0,5% 10 mg pada Pasien Kanker Serviks yang Menjalani Brakhiterapi di RSUP Dr. Sardjito

HAJAR RAFIKA RANI, dr. Bhirowo Yudo Pratomo, SpAn, KAKV;dr. Juni Kurniawaty, SpAn, M. Sc, KAKV

2021 | Tesis-Spesialis | ANESTESIOLOGI DAN TERAPI INTENSIF

Latar belakang: Levobupivacaine merupakan S-enantiomer bupivacaine, memiliki efek serupa tapi kurang kardiotoksik dibanding bupivacaine. Penelitian ini bertujuan mengetahui efektivitas blok sensorik, motorik, pemulihan dan kejadian hipotensi pada levobupivacaine 7,5 mg dibanding levobupivacaine 10 mg pada brakiterapi intrakaviter. Metode: Studi prospektif acak tersamar tunggal dengan kriteria inklusi: ASA I-II, TB 140-165 cm, usia 18-65 tahun, BMI<30 kg/m2. Sebanyak 115 sampel dilakukan randomisasi, dibagi 2 kelompok: kelompok levobupivacaine isobarik 0,5% 7,5 mg dan kelompok levobupivacaine isobarik 0,5% 10 mg. Hasil: Ketinggian sensorik kelompok levobupivacaine 7,5 mg dan levobupivacaine 10 mg sebagian besar mencapai T10 tidak berbeda bermakna secara statistik (p:0,430), onset sensorik kelompok levobupivacaine 7,5 mg lebih lama dari levobupivacaine 10 mg berbeda bermakna secara statistik (p:0,009) tapi secara klinis tidak bermakna, durasi sensorik kelompok levobupivacaine 7,5 mg lebih cepat dibanding kelompok levobupivacaine 10 mg bermakna secara statistik (p:0,005), pemulihan kelompok levobupivacaine 7,5 mg lebih cepat dibanding kelompok levobupivacaine 10 mg berbeda bermakna secara statistik (p:0,000). Kedua kelompok durasi sensorik dan motoriknya mencukupi durasi brakiterapi, tidak ada hipotensi. Brakiterapi intrakaviter berjalan baik dengan ketinggian blok sensorik <T10 dan skor bromage <2. Kesimpulan: Anestesi spinal pada kelompok levobupivacaine 7,5 mg sama efektif dengan kelompok levobupivacaine 10 mg untuk pasien kanker serviks yang menjalani brakiterapi intrakaviter.

Background: Levobupivacaine is an S-enantiomer of bupivacaine, has a similar effect but less cardiotoxic than bupivacaine. The aim of this study was to evaluate the effectiveness of 7,5 mg levobupivacaine compared with 10 mg levobupivacaine in terms of sensory block, motor, recovery and the incidence of hypotension in intracavitary brachytherapy. Methods: A prospective, randomized, single-blinded study with inclusion criteria: ASA I-II, 140-165 cm of height, 18-65 years, BMI <30 kg/m2. One hundred fifteen samples were randomized and divided into 2 groups: 0,5% isobaric levobupivacaine 7,5 mg and 10 mg. Results: Sensory height of 7.5 mg levobupivacaine and 10 mg levobupivacaine groups reached T10 were not statistically significant (p:0.430), the onset of 7.5 mg levobupivacaine group was longer than 10 mg levobupivacaine group statistically significant (p:0.009) but clinically was not significant. Sensory duration of 7.5 mg levobupivacaine group was faster than 10 mg levobupivacaine group statistically significant (p:0.005), Recovery of 7.5 mg levobupivacaine group was faster than 10 mg levobupivacaine group statistically significant (p:0,000). Both groups, sensory and motoric duration were sufficient for duration of brachytherapy. Both groups had no hypotension. Intracavitary brachytherapy worked well with sensory block height <T10 and bromage score <2. Conclusion: Spinal anesthesia with levobupivacaine 7.5 mg group was as effective as 10 mg levobupivacaine group for cervical cancer patients underwent intracavitary brachytherapy.

Kata Kunci : Brakiterapi intrakaviter, kanker serviks, anestesi spinal, levobupivakain isobaric dosis rendah