PERBANDINGAN EFEK PENAMBAHAN ANTARA KLONIDIN (50 μg) DAN FENTANYL (25 μg) SEBAGAI ADJUVAN BUPIVACAIN HYPERBARIK 0,5 % 12,5 MG INTRATHEKAL SEBAGAI ANESTESI SPINAL

Yosy Budi Setiawan, Dr. Pandit Sarosa, Sp.An., (K),

2013 | Tesis | S2 Ked.Klinik/MS-PPDS

Latar belakang. Penambahan obat adjuvant pada anestesi spinal mempunyai beberapa tujuan, salah satunya adalah untuk memperpanjang durasi blok sensorik (analgesia) subarachnoid block (SAB). Klonidin dan fentanil merupakan obat adjuvant bupivacain yang mempunyai keuntungan dan kerugian yang berbeda. Klonidin merupakan salah satu obat adjuvant dalam anestesi spinal yang mempunyai efek memperkuat analgesi pada teknik neuroaksial blok dengan cara berikatan pada reseptor postsinaps α-2 adrenergik kornu dorsalis medula spinalis. Keuntungan klonidin tidak menyebabkan depresi pernafasan dan pruritus, namun menyebabkan hipotensi dan bradikardi. Fentanil mempunyai efek analgesi, sedasi, depresi pernafasan, bahkan pada dosis tinggi dapat menyebabkan penurunan kesadaran, efek samping berupa pruritus. Tujuan penelitian. Untuk mengetahui perbandingan efek penambahan klonidin 50 µg dan fentanyl 25 µg sebagai adjuvant bupivacain 0,5% hyperbaric 12,5 mg intrathekal pada anestesi spinal meliputi: onset anestesi spinal, lama kerja blok sensorik dan motorik serta efek samping seperti hipotensi, bradikardi, mual dan muntah. Metode penelitian. Rancangan penelitian menggunakan uji klinis acak terkontrol dengan pembutaan ganda. Subyek penelitian 80 pasien, usia 18-66 tahun, berat badan 40-75 kg, status fisik ASA I & II. Pengamatan dilakukan terhadap onset SAB, durasi blok sensorik dan motorik SAB dengan metode Pinprick dan skala Bromage, serta terjadinya efek samping. Analisis data menggunakan independent samples t-test dan chi-square, bermakna bila p < 0,05, dengan tingkat kepercayaan 95%. Hasil penelitian. Diperoleh onset analgesia maksimal klonidin dibanding fentanil (8,30 ± 1,471vs 8,10 ± 1,566 menit); regresi 2 segmen (104,22 ± 22,903 vs 79,32 ± 15,714), regresi sampai segmen S2 (251,25 ± 28,233 vs 181,62 ± 33,174), dan lama kerja blom motorik (229,38 ± 35,377 vs 160,38 ± 36,557). Secara statistik terdapat perbedaan bermakna (p < 0,05; p = 0,001) regresi 2 segmen, regresi sampai segmen S2, dan lama kerja blok motorik antara kelompok klonidin dan kelompok fentanil. Tidak ada perbedaan efek samping berupa hipotensi, bradikardi, dan mualmuntah pada kelompok klonidin 50 µg dan kelompok fentanyl 25 µg. Kesimpulan. Penambahan klonidin 50 µg pada bupivacain hiperbarik 0,5% 12,5 mg dapat memperpanjang blok sensorik dan motorik, serta meminimalkan efek samping dibandingkan penambahan fentanyl 25 μg pada bupivacain hiperbarik 0,5% 12,5 mg pada anestesi spinal.

Background. The addition of the adjuvant to spinal anesthesia has several objectives, one of which is to extend the duration of sensory block (analgesia) subarachnoid block (SAB). Clonidine is a drug and fentanyl bupivacain adjuvant that has distinct advantages and disadvantages. Clonidine is one of the adjuvant drug in spinal anesthesia which has the effect of reinforcing the techniques neuroaksial block analgesia by binding to the receptor α-2 adrenergic postsinaps dorsal horn spinal cord. Advantages clonidine does not cause respiratory depression and pruritus, but causes hypotension and bradycardia. Fentanyl has the effect of analgesia, sedation, respiratory depression, even at high doses can cause loss of consciousness, side effects such as pruritus. Objective. To compare the effects of adding clonidine 50 µg and fentanyl 25 µg as adjuvant bupivacain 12.5 mg of 0.5% hyperbaric spinal anesthesia intrathekal on include: onset of spinal anesthesia, long working sensory and motory block and side effects such as hypotension, bradycardia, nausea and vomiting. Methods. The design of studies using double blind randomized controlled trial. The subject of study in 80 patients, aged 18-66 years, weight 40-75 kg, ASA physical status I & II. Data were collected for SAB onset, duration of sensory and motory block SAB Pinprick method and Bromage scale, and the occurrence of side effects. Analysis of data using independent samples t-test and chi-square, significant when p <0.05, with a confidence level of 95%. Result. Retrieved onset of analgesia than fentanyl maximum clonidine (8.30 ± 1.471 vs. 8.10 ± 1.566 min); regression 2 segments (104.22 ± 79.32 vs 22.903 ± 15.714), regression to segment S2 (251.25 ± 28.233 vs. 181.62 ± 33.174), and length of employment blom motor (229.38 vs 160.38 ± 35.377 ± 36.557). There were statistically significant differences (p <0.05, p = 0.001) 2 segment regression, regression to the S2 segment, and working long motor block between the clonidine and fentanyl groups. There is no difference in side effects such as hypotension, bradycardia, and nause-vomiting in clonidine 50 µg group and fentanyl 25 µg group. Conclusion. The addition of clonidine 50 µg on bupivacain 12.5 mg of 0.5% hyperbaric can prolong sensory and motory block, and minimizing side effects than the addition of fentanyl 25 µg on bupivacain 12.5 mg of 0.5% hyperbaric in spinal anesthesia.

Kata Kunci : Subarachnoid Block (SAB), Bupivacain hiperbarik, Klonidin, Fentanyl, Onset, Durasi blok sensorik dan motorik.