UJI BANDING DURASI BLOK SENSORIK & MOTORIK ANTARA BUPIVACAIN 7,5 MG + FENTANYL 15 μG DENGAN BUPIVACAIN 12,5 MG PADA SEKSIO SESAREA DENGAN SPINAL ANESTESI

SOFIAN HASIBUAN, Dr. Bambang Suryono SpAn, M.Kes, KNA, KIC

2012 | Tesis | S2 Ked.Klinik/MS-PPDS

Latar belakang: SAB pada operasi SC yang menggunakan Bupivacain 0.5% hyperbarik 12,5 mg sering menimbulkan problem seperti hipotensi, shivering, mualmuntah serta kelumpuhan kaki yang lama pulih. Salah satu cara untuk mengurangi efek samping diatas yaitu dengan menurunkan dosis anastesi lokal dan menambahkan opioid untuk mempertahankan kualitas analgesia. Metode: Randomized control trial dengan pembutaan ganda ini membandingkan durasi blok sensorik dan blok motorik antara Bupivacain 0.5% hyperbarik 7,5 mg + fentanyl 15 μg dengan Bupivacain 0.5% hyperbarik 12,5 mg. Tiga puluh enam perempuan hamil, usia antara 20 – 45 th dengan status fisik ASA I – II, yang menjalani bedah sesar elektif maupun emergency, dan lama operasi tidak lebih dari 120 menit di Gedung Bedah Sentral Terpadu (GBST) atau Kamar operasi UGD RSUP DR. Sardjito Yogyakarta, yang akan dilakukan anestesi regional dengan teknik Subarachnoid Block (SAB). Subyek dibagi dua kelompok masing-masing 18 pasien. Bupivacaine hyperbaric 7,5 mg + fentanyl 15 μg (Kelompok A), dengan Bupivacain hyperbaric 12,5 mg (Kelompok B). SAB dilakukan pada posisi duduk, penyuntikan pada ruang inter vertebra L3-4, dengan jarum spinal ukuran 25 G. Semua subyek dinilai status hemodinamik (tekanan darah, MAP, heart rate), durasi blok sensorik dan motorik. Hasil: Hasil penelitian durasi blok motorik pada kelompok A 102,05±7,91 menit, dibandingkan kelompok B 133,88±15,67 menit, secara statistik bermakna (p=0,000) yaitu waktu untuk mencapai Bromage Score 0. Durasi sensorik yang dicerminkan dengan regresi sampai S2 (A=158,23±10,74 vs B=166,94±10,99 menit) secara statistik juga berbeda bermakna (p= 0,024). Dari hasil penelitian juga didapatkan rata-rata lama operasi SC (A=78,52±17,38 dan B=82,50±26,74), jenis operasi dan status fisik (ASA), secara statistik tidak berbeda bermakna. Ketinggian blok spinal maksimal T4 kelompok A Vs B (52,9% vs 38,8%, p=0,348) dan T6 (41,1% vs 61,1%, p=0,286) secara statistik juga tidak berbeda bermakna. Efek samping hipotensi, shivering, mual-muntah, secara statistik juga tidak berbeda bermakna. Kesimpulan: Bupivakain 0,5% hiperbarik 7,5 mg + Fentanyl 15 μg mempunyai lama kerja blok sensorik lebih pendek dibanding bupivakain hiperbarik 0,5% 12,5 mg pada SC dengan spinal anestesi, bupivakain 0,5% hiperbarik 7,5 mg + Fentanyl 15 μg mempunyai lama kerja blok motorik lebih pendek dibanding bupivakain hiperbarik 0,5% 12,5 mg, tetapi masih cukup untuk operasi SC.

Background: SAB in SC surgery using 12.5 mg hyperbaric bupivacaine 0.5 % often caused problems such as hypotension, shivering, nausea-vomiting and long recovery of legs paralysis. The methods to eliminate those motoric block was to decrease local anesthesia dose and to add opioid to maintain analgesia quality. Method: The study used double-blind randomized control trial by comparing sensoric and motoric block durations between 7.5 mg hyperbaric bupivacaine 0.5 % + 15 μg fentanyl with 12.5 mg hyperbaric bupivacaine 0.5 %. Thirty six pregnant women of 20- 45 of age with the physica status of ASA I-II, undergoing elective SC and emergency with the operation duration of not more than 120 minutes in The Central Operation Theatre (COT) or Emergency Operation Room of DR. Sardjito Hospital Yogyakarta under regional anesthesia with Subarachnoid Block technique (SAB). The subjects of the study were assigned to two groups of 18 patients. 7.5 mg hyperbaric bupivacaine 0.5 % + 15 μg fentanyl (Group A) with 12.5 mg hyperbaric bupivacaine 0.5 % (Group B). The SAB was conducted on sitting possition with the injection of inter vertebra L2-4 space using spinal needle of 25 G. The hemodinamic status (blood pressure, MAP, and heart rate) and the sensoric and motoric block duration of all of the subjects were measured. Results: The results of the study showed that the motoric block duration of the Group A 102.05±7.91 minutes as compared to the Group B 133.88±15.67 minutes was significant (p=0.000), which was tht time to reach the Bromage Score 0. The sensoric duration reflected with the regression to S2 (A=158,23±10,74 vs B=166,94±10,99 minutes) and it was also statistically different (p= 0.024). From the results of the study also found that the mean of duration of SC was (A=78,52±17,38 and B=82,50±26,74), the kind of operation and the physical status (ASA) did not differ significantly. The maximal analgesia height T4 of Grup A vs B (52,9% vs 38,8%, p=0,348) dan T6 (41,1% vs 61,1%, p=0,286) did not significantly differ. The side effects of hypotension, shivering, nauseavomiting did not significalty differ. Conclusion: 7.5 mg hyperbaric bupivacaine 0.5 % + 15 μg fentanyl had shorter duration of sensoric block than 12.5 mg hyperbaric bupivacaine 0.5 % for SC with spinal anesthesia. 7.5 mg hyperbaric bupivacaine 0.5 % + 15 μg fentanyl had shorter duration of motoric block than 12.5 mg hyperbaric bupivacaine 0.5 % , but it was sufficient for the SC

Kata Kunci : Blok subarahnoid, nyeri persalinan, bupivacain, fentanyl.