PERBANDINGAN DAYAGUNA PENAMBAHAN FENTANIL 20 μg DAN MEPERIDIN 10 MG INTRATEKAL DALAM BUPIVAKAIN 0,5% HIPERBARIK 10 MG UNTUK PENCEGAHAN SHIVERING (Pada Seksio sesaria dengan Anestesi spinal)
Fakhruddin Noor, Dr. Bhirowo Yudo P, SpAn.K.,
2012 | Tesis | S2 AnestesiologiLatar belakang. Teknik anestesi spinal banyak dipilih untuk seksio sesaria, karena lebih sederhana dan onset cepat, namun komplikasi kejadian shivering 45- 85%. Penggunaan opioid intratekal terutama Meperidin sebagai adjuvant obat lokal anestesi untuk mencegah shivering mempunyai efek samping yang besar. Fentanil sebagai adjuvant obat lokal anestesi intratekal mempunyai sifat ionisasi lebih cepat dan lipolisitas yang kuat, yang dapat mengurangi efek samping sebagaimana yang muncul pada pemberian adjuvant Meperidin. Tujuan penelitian. Untuk mengetahui daya guna penambahan Fentanil 20 µg intratekal dibanding Meperidin 10 mg intratekal dalam bupivakain 0,5% hiperbarik 10 mg dalam mencegah shivering pada seksio sesaria dengan anestesi spinal. Metode penelitian. Menggunakan uji klinik acak terkontrol tersamar ganda. Jumlah sampel 122 pasien yang sesuai dengan kriteria inklusi dan eksklusi. Sampel dibagi dua kelompok masing-masing 61 pasien. Kelompok F (bupivakain 0,5% hiperbarik 10 mg ditambahkan Fentanil 20 µg intratekal) dan kelompok M (bupivakain 0,5% hiperbarik 10 mg ditambahkan Meperidin 10 mg intratekal). Analisis data menggunakan independent t-tes dan chi-square dengan derajat kemaknaan p<0,05 dan tingkat kepercayaan 95%. Hasil penelitian. Kejadian shivering secara kumulatif selama operasi dan setelah operasi lebih kecil kelompok F (13,1%) dibandingkan kelompok M (29,5%). Kejadian shivering selama operasi maupun setelah operasi lebih kecil pada kelompok F masing-masing 11,5% dan 1,6% dibandingkan kelompok M 18,0% dan 11,5%. Secara statistik bermakna (p<0,05). Derajat shivering selama operasi dan setelah operasi terbanyak adalah derajat 2, selama operasi 4,9% untuk kelompok F sedangkan kelompok M sebesar 13,1%. Setelah operasi 1,6% untuk kelompok F sedangkan kelompok M sebessar 11,5%. Efek samping mual dan pruritus lebih banyak terjadi pada kelompok M (34,4% dan 3,3%) dibandingkan dengan kelompok F (3,3% dan 1,6%). Secara statistik bermakna (p<0,05%). Kesimpulan. Penambahan Fentanil 20 µg intratekal lebih berdayaguna dibandingkan Meperidin 10 mg intratekal untuk mencegah shivering pada seksio sesaria dengan anestesi spinal, serta efek samping minimal. .
Background. Spinal anesthesia technique is frequently chosen for cesarean section, because it is considered more efficient and has faster onset of blockage; however, it presents shivering problems of 45-85%. The use of intrathecal opioids in particular Meperidine as an adjuvant drug to local anesthetics for the prevention of shivering has big side effects. Fentanyl as an adjuvant drug to local anesthetics has the working mechanism experiencing faster ionized process and having strong lipophilic in nature that can reduce side effects as what emerges in the administrationof adjuvant drugs as Meperidine. Research purpose. To determine the efficacy of the addition of fentanyl 20 µg intrathecally compared with Meperidine 10 mg intrathecally in bupivacaine 0.5% hyperbaric 10 mg to prevent shivering in cesarean section with spinal anesthesia.. Methods.This study was a randomized controlled double-blind clinical trial. The number of samples was 122 patients according to the inclusion and exclusion criteria. The samples were divided into two groups, each of 61 patients. Group F was the group with bupivacaine 0.5% hyperbaric 10 mg added with fentanyl 20 µg intrathecally and Group M was the group with bupivacaine 0.5% hyperbaric 10 mg added with Meperidine 10 mg intrathecally. Data analysis used independent ttest and chi-square with degree of significance p <0.05 and 95% Confidence Interval. Result. Shivering during and post surgery cumulatively was smaller in Group F (13.1%) than that in Group M (29.5%). Shivering during and post surgery was smaller in Group F by 11.5% and 1.6%, respectively compared with that in Group M by 18.0% and 11.5%, respectively. This result was statistically significant (p<0.05). The most degree of shivering during and post surgery was 2 in which during operation Group F and M obtained 4.9% and 13.1% and in post operation Group F and M obtained 1.6% and 11.5, respectively. Side effects in form of nausea and pruritus were more likely to happen in Group M (34.4% and 3.3%) than in Group F (3.3% and 1.6%); this was statistically significant (p<0.05%). Conclusion. The addition of intrathecal fentanyl 20 ug was far more efficacious than that of intrathecal Meperidine 10 mg to prevent shivering in cesarean section with spinal anesthesia and it had minimal side effects.
Kata Kunci : Fentanil, Meperidin, shivering, seksio sesaria, anestesi spinal
