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Ilham Wahyudi Soamole
Efek analgesia penambahan deksametason 8 mg pada blok tranversus abdominal plane tiga titik dibandingkan dengan epidural kontinyu pascalaparoskopi nefrektomi = Analgesia effect of adding dexamethasone 8 mg in three point plane tranversus abdominis block compared to continuous epidural for postoperative laparoscopic nephrectomy
"Latar Belakang: Tatalaksana nyeri pascabedah pada pasien pascalaparoskopi nefrektomi merupakan salah satu kunci pemulihan dini pasien. Di RSUPN Cipto Mangunkusomo, hampir semua pasien donor ginjal pascabedah laparoskopi nefrektomi mendapatkan analgesia epidural kontinyu. Masih tingginya persentase pasien dengan derajat nyeri berat, serta terdapatnya efek samping retensi urin pascaanalgesia epidural kontinyu, membuka kemungkinan untuk digunakannya teknik analgesia berbasis anestesia regional lain yang lebih baik. Blok tranversus abdominis plane dapat digunakan sebagai analgesia pascabedah abdomen, aman digunakan pada pasien dengan gangguan fungsi koagulasi dan tidak menyebabkan terjadinya retensi urin dibandingkan dengan teknik blok neuraksial. Metode: Penelitian ini bersifat uji klinis terkendali tidak tersamar tunggal, dengan populasi semua pasien donor ginjal yang menjalani laparoskopi nefrektomi pada bulan Mei-Oktober 2017 di RSUPN Cipto Mangunkusumo. Sebanyak 25 subyek pada dua kelompok diambil dengan metode consecutive sampling. Analisa statistik dilakukan untuk mengetahui efek analgesia penambahan deksametason 8 mg pada blok TAP tiga titik, rata-rata derajat nyeri gerak dan kebutuhan morfin pascabedah pada kedua kelompok dengan menggunakan uji Mann-Whitney dan uji Friedman dan post hoc Wilcoxon.Hasil: Uji Mann-Whitney rata-rata nyeri diam tidak berbeda signifikan p 0,066-0,716 . Uji Mann-Whitney Kebutuhan PCA morfin pada 24 jam pascabedah tidak berbeda signifikan p 0,072-0,200 . Perubahan derajat nyeri pada blok TAP dengan uji Friedman dan post hoc Wilcoxon bermakna signifikan p 0,002 dan 0,020 . Kebutuhan morfin pada blok TAP dengan uji Friedman dan post hoc Wilcoxon bermakna signifikan p 0,023 . Saat pertama menggunakan tambahan morfin dan awal mobilisasi pascabedah tidak ada perbedaan pada kedua kelompok. Kekerapan retensi urin pascabedah lebih tinggi pada epidural kontinyu 58.01 .Simpulan: Penambahan deksametason 8 mg tidak memberikan efek analgesia yang lebih baik pada blok TAP tiga titik dibanding epidural kontinyu. Jumlah penggunaan morfin, saat pertama membutuhkan tambahan morfin, rata-rata derajat nyeri gerak dan awal mobilisasi pascabedah tidak berbeda signifikan pada blok TAP tiga titik dengan epidural kontinyu. Kekerapan retensi urin pascabedah lebih tinggi pada epidural kontinyu.
Abstract Background Postoperative pain management in laparoscopic nephrectomy is one key to early recovery. At RSUPN Cipto Mangunkusomo, almost all postoperative laparoscopic donor nephrectomy patients acquire continuous epidural analgesia. High percentage of patients with severe degree of pain and presence of postoperative urinary retention related to continuous epidural opens the possibility of better use of other regional anesthesia analgesia techniques. Tranversus abdominis plane block can be used as postoperative analgesia in abdominal surgery, safe in patients with impaired coagulation function and does not cause urinary retention compared with neuraxial block technique. Methods Randomized control trial in all kidney donor patients undergoing laparoscopic donor nephrectomy in RSUPN Cipto Mangunkusomo during May October 2017. Consecutive sampling and random allocation was done to put 25 patients in each TAP block and Continuous Epidural group. Statistical analysis was performed to determine the effect of adding 8 mg of dexamethasone in three point TAP block on degree of pain at rest and with movement and postoperative morphine requirements using Mann Whitney, Friedman and post hoc Wilcoxon test. Results Mann Whitney test showed no significant difference in pain at rest p 0,066 0,716 and 24 hours postoperative morphine requirements p 0,072 0,200 between two groups. Friedman and post hoc Wilcoxon test showed a significant difference in degree of pain p 0,002 and 0,020 and morphine requirement p 0,023 in TAP block group. There is no difference in time to first dose of morphine rescue and early postoperative mobilization. There is higher incidence of postoperative urinary retention in continuous epidural group 58.01 .Conclusion The addition of dexamethasone 8 mg on three point TAP block did not provide better analgesia than continuous epidural. The amount of morphine requirement, time to first dose of morphine rescue, degree of pain at rest and with movement and early postoperative mobilization did not differ significantly between two groups. The frequency of postoperative urinary retention is higher with continuous epidural."
Depok: Universitas Indonesia, 2017
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UI - Tugas Akhir  Universitas Indonesia Library
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Hasan Basri, 1967-
Perbaikan pola sirkadian tekanan darah donor ginjal dengan ambulatory blood pressure monitoring pada 12 minggu pasca nefrektomi = Normalization of blood pressure circadian rhythm in kidney donors within 12 weeks post nephrectomy
"[ABSTRAK
Latar Belakang : Isu yang berkembang pada donor ginjal hidup adalah penurunan fungsi ginjal dan terjadinya hipertensi setelah dilakukan nefrektomi. Satu minggu setelah nefrektomi pola tekanan darah sirkadian berubah menjadi non dipper. Selanjutnya terjadi kompensasi sehingga fungsi ginjal akan stabil dalam 12 minggu. Namun belum diketahui apakah perbaikan fungsi ginjal akan diikuti oleh pola tekanan darah sirkadian kembali menjadi dipper.
Tujuan : Untuk mengetahui perubahan pola sirkadian tekanan darah donor ginjal hidup setelah 12 minggu nefrektomi unilateral.
Metode Penelitian : Studi Pre-experimental dengan before and after design. Subyek sebanyak 18 orang donor ginjal hidup sehat yang berusia 18-50 tahun . Peneltian dilakukan di RSCM pada bulan Januari 2015 sampai dengan Mei 2015. Tekanan darah diukur dengan 24 jam ABPM . Pemeriksaan kreatinin darah, eLFG epi dan uACR dilakukan sebelum nefrektomi, pada 1 minggu dan 12 minggu setelah nefrektomi.
Hasil :Terdapat 18 subyek yang memiliki pola dipper sebelum dilakukan nefrektomi unilateral. Tujuh belas subyek mengalami pola non dipper setelah 1 minggu nefrektomi. Pada 12 minggu setelah nefrektomi 16 diantaranya kembali menjadi pola dipper yang bermakna secara statistik (p<0.001).
Simpulan : Terdapat perubahan pola sirkadian tekanan darah non dipper kembali menjadi pola dipper pada donor ginjal hidup 12 minggu setelah nefrektomi unilateral.ABSTRACT Background : The issue of post nephrectomy in living kidney donor is kidney function decrease and hypertension. One week after nephrectomy circadian pattern of blood pressure becomes non dipper. Then there will be a compensatory of renal function that becomes stable within 12 weeks after nephrectomy. However, whether the improvement of renal function is followed by the circadian pattern of blood pressure becomes dipper is still unknown.
Aims : To know the changes circadian pattern of blood pressure among living kidney donors 12 weeks after unilateral nephrectomy.
Methods : A pre-experimental study with before and after design. The subjects were 18 healthy living kidney donors aged 18 to 50 years old , conducted in RSCM hospital between January 2015 to May 2015. Blood pressure was measured by 24 hours ABPM. Serum creatinine, e-GFR epi and uACR were taken before nephrectomy, 1 week and 12 weeks after nephrectomy.
Results : There were 18 subjects had dipper pattern before unilateral nephrectomy. Seventeen of them exhibited a pattern became non dipper on one week after nephrectomy. Sixteen subjects showed the pattern returned to dipper after 12 weeks nephrectomy that statistically significant (p<0.01)
Conclusions : The circadian pattern of blood pressure returned to dipper from non dipper on living kidney donors after 12 weeks unilateral nephrectomy., Background : The issue of post nephrectomy in living kidney donor is kidney function decrease and hypertension. One week after nephrectomy circadian pattern of blood pressure becomes non dipper. Then there will be a compensatory of renal function that becomes stable within 12 weeks after nephrectomy. However, whether the improvement of renal function is followed by the circadian pattern of blood pressure becomes dipper is still unknown.
Aims : To know the changes circadian pattern of blood pressure among living kidney donors 12 weeks after unilateral nephrectomy.
Methods : A pre-experimental study with before and after design. The subjects were 18 healthy living kidney donors aged 18 to 50 years old , conducted in RSCM hospital between January 2015 to May 2015. Blood pressure was measured by 24 hours ABPM. Serum creatinine, e-GFR epi and uACR were taken before nephrectomy, 1 week and 12 weeks after nephrectomy.
Results : There were 18 subjects had dipper pattern before unilateral nephrectomy. Seventeen of them exhibited a pattern became non dipper on one week after nephrectomy. Sixteen subjects showed the pattern returned to dipper after 12 weeks nephrectomy that statistically significant (p<0.01)
Conclusions : The circadian pattern of blood pressure returned to dipper from non dipper on living kidney donors after 12 weeks unilateral nephrectomy.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Cynthia Afriany
Perbedaan distribusi ventilasi antara penggunaan volume tidal 6 ml/kgbb dengan 10 ml/kgbb pada operasi laparoskopi nefrektomi dengan penilaian electrical impedance tomography:penelitian pada donor transplantasi ginjal = Distribution of ventilation difference between the use of tidal volume 6 ml/kgbw with 10 ml/kgbw/kgbb on nefrektomi laparoscopic surgery with electrical impedance tomography assessment research on kidney transplant donor
"Latar Belakang: Laparoskopi merupakan prosedur yang menguntungkan pada operasi transplantasi ginjal . Namun teknik ini dapat menyebabkan perubahan pada sistem pernafasan. Pengaturan volume tidal merupakan salah satu strategi proteksi untuk mencegah komplikasi paru pascaoperatif. Penelitian ini berusaha membandingkan efek volume tidal 6 mL/kgbb dan 10 mL/kgbb terhadap distribusi ventilasi pada pasien donor transplantasi ginjal yang menjalani nefrektomi per laparoskopi menggunakan EIT.
Metoda: Uji klinis ini dilakukan di Instalasi Bedah Pusat RSUPN Cipto Mangunkusumo dan ruang operasi RSCM Kencana Jakarta terhadap 30 pasien donor transplantasi ginjal yang menjalani laparoskopi nefrektomi. Subjek dirandomisasi ke dalam 2 kelompok intervensi: ventilasi mekanik intraoperatif dengan volume tidal 6 mL/kgbb dan 10 mL/kgbb. Hipotesis penelitian adalah distribusi ventilasi volume tidal 6 mL/kg lebih baik dibandingkan 10 mL/kg. Parameter yang dinilai adalah ?TIV, ?EELI global dan regional dan ?CR diambil dari monitor EIT PulmoVista 500.
Hasil: Nilai ∆TIV paru dependen dan nondependen antara kedua kelompok berbeda bermakna secara statistik pada posisi supine pascadesuflasi (p =0,008), dimana volume tidal 6 mL/kgbb menunjukkan distribusi ventilasi tidak homogen. Nilai ∆EELI global dan regional volume tidal 10 mL/kg lebih tinggi dan bermakna secara statistik pada posisi lateral dekubitus sebelum insuflasi (p <0,005). Tidak ditemukan perbedaan bermakna nilai ∆CR (paru dependen dan nondependen).
Simpulan. Pemberian volume tidal 6 mL/kgbb tidak memberikan gambaran distribusi ventilasi yang lebih baik dibandingkan dengan volume tidal 10 mL/kgbb pada pasien donor ginjal yang menjalani operasi laparoskopi nefrektomi berdasarkan parameter EIT.
Background: Laparoscopy is a procedure that is profitable on a kidney transplant operation. However, this technique may cause changes in the respiratory system. Tidal volume setting is one of protection strategies for preventing pulmonary complications postoperative. This study attempted to compare the effects of tidal volume 6 mL kgbw and 10 mL kgbb kgbw against distribution of ventilation in kidney transplant donor patients who underwent laparoscopic nephrectomy using EIT.
Method: This randomized clinical trial conducted in the Surgical Center Installation RSUPN Cipto Mangunkusumo and operating room RSCM Kencana Jakarta against 30 kidney transplant donor patients who underwent laparoscopic nephrectomy. Subjects were randomized into two intervention groups mechanical ventilation with intraoperative tidal volume 6 mL kgbw and 10 mL kgbw. The hypothesis is distribution of ventilation tidal volume 6 mL kgbw is better than 10 mL kgbw. Parameter TIV, EELI global and regional and CR were taken from a monitor EIT PulmoVista 500.
Result: The value of TIV between dependent and nondependent parts of lung statistically significant difference on postdesuflation supine position p 0,008 , where the tidal volume of6 mL kgbw indicates distribution of ventilation is not homogenous. The value of EELI global and regional tidal volume 10 mL kg is higher and meaningful statistically on lateral decubitus before insuflation p 0,005 . There is no meaningful difference in CR value the dependent and nondependent parts of lung.
Conclusion: Tidal volume 6 mL kgbw does not give a better distribution of ventilation compared with 10 mL kgbw in kidney donor patient undergoing laparoscopic nephrectomy based on the parameters of the EIT.Keywords Distribution of ventilation, EIT, kidney donor, laparoscopic nephrectomy, intraoperative volume tidal."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Febrian Putra
Perbandingan blok erector spinae plane (esp) dengan quadratus lumborum (ql) terhadap nyeri kronik pascabedah laparoskopik donor ginjal hidup teknik retroperitoneum = Comparison of erector spinae plane (esp) blocks and quadratus lumborum (ql) for chronic pain post laparoscopic surgery of living kidney donor retroperitoneum techniques
"Pendahuluan: Nefrektomi donor hidup perlaparoskopi adalah pendekatan standar emas untuk bedah ginjal donor hidup dikaitkan dengan nyeri pascabedah yang lebih ringan. RSUPN Dr. Cipto Mangunkusumo merupakan pusat transplantasi ginjal terbesar di Indonesia. Saat ini pembedahan donor ginjal hidup dilakukan dengan menggunakan pendekatan transperitoneum menjadi retroperitoneum untuk mengurangi komplikasi berupa cidera organ viseral. Perubahan ini menyebabkan teknik blok tranverse abdominis plane (TAP) dan blok quadratus lumborum (QL) pendekatan anterior dianggap tidak memadai sebagai suplementasi analgesia intraoperatif, teknik anestesi regional yang dianggap tepat untuk pendekatan retroperitoneal adalah teknik blok erector spinae plane (ESP) dan blok QL pendekatan anterior subcostal yang terletak lebih posterior. Brief Pain Inventory (BPI) merupakan salah satu instrumen yang dapat menilai derajat nyeri dan gangguan nyeri kronik terhadap kegiatan sehari-hari yang digunakan dalam penelitian ini.
Metode: Penelitian dilakukan dengan desain kohort retrospektif untuk analisis insiden dan derajat nyeri kronik terhadap teknik blok ESP dan blok QL pada pasien laparoskopik donor ginjal hidup dengan teknik retroperitoneum di RSUPN Dr. Cipto Mangunkusumo. Sampel yang akan diambil di penelitian ini adalah semua pasien laparaskopi donor ginjal hidup teknik retroperitoneal minimal tiga bulan pascabedah sampai bulan Oktober 2022 dengan jumlah sampel 138 orang. Dilakukan juga analisa hubungan antara teknik blok dengan derajat akut, hubungan derajat nyeri akut, konsumsi opioid intraoperatif dan jenis analgesia pascabedah terhadap nyeri kronik dan hubungan karakteristik pasien terhadap nyeri kronik.
Hasil: Teknik blok ESP dan blok QL tidak berbeda bermakna terhadap insiden (p=0,317) dan derajat nyeri kronik (p=1,000) pascabedah. Insiden nyeri kronik pascabedah laparaskopi donor hidup teknik retroperitoneal adalah 41 orang (27,7%) dengan karakteristik nyeri kronik derajat ringan 39 orang (95,2%). Teknik blok ESP dan blok QL berbeda bermakna terhadap derajat nyeri akut H-0 (p=0,045) dan derajat nyeri akut pascabedah bermakna terhadap insiden nyeri kronik pascabedah (p=0,04). Terdapat hubungan bermakna antara karakteristik pasien pada status pekerjaan (p=0,032) dan jangka waktu pascabedah (p=0,05) terhadap insiden nyeri kronik pada pasien laparoskopik donor ginjal hidup teknik retroperitoneum.
Kesimpulan: Teknik blok ESP dan blok QL tidak berbeda bermakna terhadap insiden dan derajat nyeri kronik pascabedah.
Introduction: Laparoscopic living donor nephrectomy is the gold standard approach for living donor kidney surgery associated with less postoperative pain. RSUPN Dr. Cipto Mangunkusumo is the largest kidney transplant center in Indonesia. Currently living kidney donor surgery is performed using a transperitoneal approach to retroperitoneum in order to reduce complications of visceral organ injury. This change causes the transverse abdominis plane (TAP) block technique and the anterior approach of quadratus lumborum (QL) block technique to be considered inadequate as a supplement for intraoperative analgesia, regional anesthetic techniques that are considered appropriate for the retroperitoneal approach are the erector spinae plane (ESP) block technique and the QL block approach more posteriorly. The Brief Pain Inventory (BPI) is an instrument that can assess the pain severity and pain interferences in daily activities used in this study.
Methods: This study was conducted with a retrospective cohort design to analyze the incidence and severity of chronic pain using the ESP block and QL block in living kidney donor laparoscopic patients using retroperitoneum technique at RSUPN Dr. Cipto Mangunkusumo. Samples taken in this study were all living kidney donor laparoscopic patients with retroperitoneal technique for at least three months postoperatively until October 2022 with a total sample of 138 people. Assessment of the correlation between block technique and acute pain severity was also carried out, the correlation between acute pain severity, intraoperative opioid consumption and types of postoperative analgesia to chronic pain and the correlation between patient characteristics and chronic pain.
Results: ESP block technique and QL block technique were not significantly different on the incidence (p=0,317) and the severity of chronic pain after surgery (p=1,000). The incidence of chronic pain after laparoscopic living donor retroperitoneal surgery was 41 people (27,7%) with mild chronic pain of 39 people (95,2%). The ESP block technique and QL block technique differed significantly on the degree of acute pain H-0 (p=0,045). The degree of acute postoperative pain was significant to the incidence of postoperative chronic pain (p=0,04) and there was a significant correlation between patient characteristics in occupational status (p=0,032) and the postoperative period to chronic pain (p=0,05).
Conclusion: The technique of ESP block and QL block did not differ significantly on the incidence and severity of postoperative chronic pain."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library