EFEK KLONIDIN 3 μg/kgBB DRIP INTRAVENA TERHADAP LAMA KERJA BLOKADE MOTORIK DAN SENSORIK PADA BLOK SUBARAHNOID

RADITSYA MADA GAUTAMA, Dr. Calcarina Fitriani R.W., SpAn,KIC

2011 | Tesis | S2 Ked.Klinik/MS-PPDS

Tujuan : Mengetahui efek pemberian klonidin 3µg/kgBB drip intravena terhadap lama kerja blokade motorik dan sensorik pada SAB dengan bupivakain 0,5% hiperbarik. Desain : Percobaan acak dengan pembutaan ganda terkontrol. Ruang lingkup :Pasien yang menjalani pembedahan daerah perineum, anggota gerak bawah, urologi, dan ginekologi elektif di Instalasi Bedah Sentral RS Dr.Sardjito Yogyakarta. Subyek : 60 pasien pria dan wanita berusia 16-65 tahun dengan status fisik ASA I-II, berat badan 40-70 kg, tinggi badan 150-170 cm (BMI 17,5-24,5kg/m 2 ), dan lama operasi < 120 menit. Intervensi : Subyek dibagi 2 kelompok, masing-masing kelompok 30 subyek dengan dropout sebesar 3 subyek. Semua subyek mendapat SAB dengan bupivakain hiperbarik 0,5% 15mg. Kelompok A mendapat NaCl 100ml, kelompok B mendapat klonidin 3µg/kgBB dalam NaCl 100ml. Obat diberikan 20 menit setelah penyuntikan SAB selama 20 menit. Pengukuran : Lama kerja blok sensorik, lama kerja blok motorik, tekanan darah, MAP, denyut jantung, laju pernafasan, dan saturasi O2. Hasil : Data demografi kedua kelompok sebanding. Hasil yang didapatkan adalah lama kerja blok sensorik kelompok A memanjang bila dibandingkan dengan kelompok B yaitu 183,90±29,29 menit vs 162,70±25,46 menit, p=0,004 p<0,05). Lama kerja blok motorik kelompok A tidak memanjang bila dibandingkan dengan kelompok B yaitu 151,00±23,80 menit vs 145,00±15,.65 menit, p=0,253 (p>0,05). Perubahan tekanan darah, MAP, denyut jantung, laju pernafasan, dan saturasi O2 tidak didapatkan perbedaan bermakna secara statistik. Kesimpulan : pemberian klonidin 3µg/kgBB drip intravena pada blok subarahnoid dengan bupivakain 0,5% hiperbarik memperpanjang lama kerja blokade sensorik. Pemberian klonidin 3µg/kgBB drip intravena pada blok subarahnoid dengan bupivakain 0,5% hiperbarik tidak memperpanjang lama kerja blokade motorik.

Objective :To assess the effect of intravenous clonidine 3µg/kg on prolongation of motoric and sensoric blockade in sub arachnoid block with hyperbaric bupivacaine 0,5%. Design : Randomized Double Blind Controlled Trial. Setting : Patients indicated for SAB, undergo perineal, lower extremity, urology, and lower gynecology elective surgery in Central Operating Theatre of Dr.Sardjito Hospital Yogyakarta. Subject : 60 subjects, men and women, ages between 16-65 years old, the phyisical status ASA I-II, body weight 40-70 kg, height 150- 170 cm (BMI 17,5-24,5 kg/m 2 , procedure less than 120 minutes. Intervention :Subject were divided into two groups. 30 subjects in each group, 3 subjects dropout. Group A was given clonidine 3µg/kgBW in NaCl 100ml. Group B was given NaCl 100ml. All interventions started 20 minutes after SAB and administered in 20 minutes. Local anesthesia for SAB was 0.5% hyperbaric bupivacaine 15 mg. Outcome measure : The main outcome measures were motoric blockade and sensoric blockade duration. Hemodynamics and respiratory parameters which were blood pressure, MAP, heart rate, respiratory rate, and O2 saturation were also measured. Results : Demographic data between two groups were comparable. Sensoric blockade duration was prolonged in the clonidine group compared to the control group i.e. 183.90 ± 29.29 minutes vs 162.70 ± 25.46 minutes, p=0.004 (p<0.05). Motoric blockade duration was not prolonged in the clonidine group compared to the control group i.e. 151.00 ± 23.80 minutes vs 145.00 ± 15.65 minutes, p=0.253 (p>0.05). Difference of blood pressure, MAP, heart rate, respiratory rate, and O2 saturation were not statistically significant. Conclusion : Clonidine 3µg/kgBW intravenously prolonged the duration of sensoric blockade in SAB with 0.5% hyperbaric bupivacaine, but it didn’t prolong the duration of motoric blockade.

Kata Kunci : klonidin intravena, blokade motorik dan sensorik, bupivakain, sub arachnoid block.