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"Latar belakang. Kombinasi anestesi spinal bupivakain dan fentanil dengan penambahan klonidin dosis tinggi diketahui dapat memperpanjang durasi blok sensorik dan motorik, namun prevalensi timbulnya efek samping cukup tinggi. Dalam studi ini, kami menggunakan klonidin dosis rendah secara intratekal (30 mcg) sebagai adjuvan  bupivakain dan fentanil. Tujuan. Penelitian dilakukan untuk membandingkan efektifitas serta efek samping pada kombinasi anestesi spinal bupivakain fentanil dengan dan tanpa klonidin 30 mcg. Metode. Penelitian studi potong lintang yang dilakukan pada 70 pasien seksio sesarea terbagi kedalam dua kelompok masing-masing 35 pasien yang mendapatkan kombinasi anestesi spinal dengan penambahan klonidin 30 mcg dan tanpa klonidin 30 mcg. Penelitian ini mengevaluasi kualitas blok sensorik dan motorik. Efek samping yang terjadi diamati selama 24 jam paska tindakan seksio sesarea meliputi pruritus, mual muntah, nyeri tungkai, nyeri punggung dan mata merah. Hasil Penelitian. Median durasi blok sensorik kelompok kombinasi anestesi bupivakain fentanil dengan klonidin 30 mcg dibandingkan tanpa klonidin 30 mcg (330 menit vs 220 menit), Median durasi blok motorik (193 menit vs 188 menit). Efek samping tertinggi adalah mual muntah terdapat pada kelompok kombinasi tanpa klonidin 30 mcg (42.85%). Perbedaan bermakna (p-value < 0.05) terdapat pada durasi blok sensorik, blok motorik dan efek samping mual muntah. Kesimpulan. Penambahan klonidin 30 mcg pada kombinasi anestesi spinal bupivakain fentanil dapat memperpanjang durasi blok sensorik dan motorik serta meminimalisir efek samping dibandingkan dengan tanpa klonidin 30 mcg.

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Background. The combination of the spinal anesthesia bupivacaine and fentanyl with the addition of high doses of clonidine are known to prolong the duration of sensory and motor blocks, but the prevalence of side effects is high. In this study, we used an intrathecally low dose of clonidine (30 mcg) as an adjuvant to bupivacaine and fentanyl.

Aim. This study was conducted to compare the effectiveness and side effects of the combination spinal anesthesia bupivacaine fentanyl with and without clonidine 30 mcg.

Method. Cross-sectional study conducted on 70 patients with cesarean section divided into two groups of 35 patients each who received a combination of spinal anesthesia with the addition of clonidine 30 mcg and without clonidine 30 mcg. This study evaluates the quality of the sensory and motor blocks. Side effects observed for 24 hours after cesarean section included pruritus, nausea, vomiting, leg pain, back pain and red eyes.

Result. Median sensory block duration in the combination group of the anesthetic bupivacaine fentanyl with clonidine 30 mcg compared without clonidine 30 mcg (330 min vs 220 min), Median motor block duration (193 min vs 188 min). The highest side effect was nausea and vomiting in the combination group without clonidine 30 mcg (42.85%). Significant differences (p-value <0.05) were found in the duration of sensory blocks, motor blocks and side effects of nausea and vomiting.

Conclusion. The addition of clonidine 30 mcg to the combination of spinal anesthesia bupivacaine fentanyl can prolong the duration of sensory and motor blocks and minimize side effects compared to 30 mcg without clonidine."

"Latar Belakang. Nyeri pascaoperasi abdomen bawah merupakan salah satu komplikasi yang sering dikeluhkan pasien. Walaupun intensitasnya lebih rendah dibandingkan nyeri pascaoperasi abdomen atas, tetapi prosedur pembedahan ini lebih sering dilakukan di rumah sakit. Penggunaan gabapentin sebagai analgesia preemtif yang diberikan dua jam sebelum operasi dilaporkan dapat mengurangi nyeri pascaoperasi dan mengurangi kebutuhan analgesia pascaoperatif pada pasien yang menjalani pembedahan. Penelitian mengenai efektivitas gabapentin oral sebagai analgesia preemtif pada operasi abdomen bawah belum pernah dilakukan di Indonesia. Metode. Uji klinis acak tersamar ganda terhadap 72 subjek yang didapatkan dengan consecutive sampling pada November 2019 – Februari 2020 di RSU Kabupaten Tangerang. Subjek yang memenuhi kriteria dirandomisasi menjadi dua kelompok untuk mendapatkan regimen analgesia preemtif gabapentin 600 mg oral atau plasebo dua jam sebelum insisi. Pasien dilakukan penilaian kebutuhan morfin, derajat nyeri, saat pertama membutuhkan morfin, dan efek samping pada kedua kelompok dalam 24 jam pertama pascaoperasi. Analisis hasil menggunakan uji general linear model (GLM) dan anova untuk pengukuran berulang dan Mann-Whitney U. Hasil. Uji GLM menunjukkan ada perbedaan bermakna pada total kebutuhan morfin dalam 24 jam pascaoperasi antara kelompok gabapentin (2,47±1,90 mg) dengan plasebo (5,33±1,97 mg; p<0,001). Derajat nyeri saat istirahat dan bergerak saat pulih sadar, 2 jam, 6 jam, 12 jam, dan 24 jam pascaoperasi antara kedua kelompok didapatkan hasil berbeda bermakna dengan p<0,05. Uji Mann-Whitney menunjukkan ada perbedaan bermakna pada saat pertama subjek membutuhkan morfin untuk rescue analgesia antara kelompok gabapentin (161,5 [25 – 990] menit) dengan plasebo (67,5 [10 – 371] menit) dengan p<0,001. Kejadian mual pada kelompok gabapentin didapatkan lebih rendah dibandingkan kelompok plasebo. Simpulan. Gabapentin 600 mg oral lebih efektif dibandingkan plasebo sebagai analgesia preemtif pada operasi abdomen bawah nonobstetrik. Kejadian mual lebih sedikit pada pemberian analgesia preemtif gabapentin.

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Background. Lower abdominal postoperative pain is one of the most common postoperative complications reported by the patients. Although the pain intensity is lower than upper abdominal postoperative pain, lower abdominal surgery procedures are more often conducted in the hospital. Gabapentin therapy as preemptive analgesia given two hours before surgery has been reported to reduce postoperative pain and decrease postoperative analgesia requirements. There have been no studies in Indonesia reporting the effectiveness of oral gabapentin as preemptive analgesia to reduce lower abdominal postoperative morphine requirements. Method. Double-blind randomized clinical trial was conducted from 72 subjects by consecutive sampling on 2019 November-2020 February at Tangerang District General Hospital. Subjects fulfilling criteria were randomized into two groups and were given gabapentin 600 mg orally or placebo two hours before incision. Patients’ morphine requirements, pain scale at the first time morphine administration, and side effects on two groups on the first 24 hour postoperative were assessed. Result analysis was conducted using general linear model (GLM) and anova for repeated measurements and Mann-Whitney U. Result. GLM showed that there was significant difference on first 24-hour postoperative total morphine requirements between gabapentin group (2.47±1.90 mg) and placebo group (5.33±1.97 mg; p<0.001). Pain scale at rest and movement while on recovery, 2 hours, 6 hours, 12 hours, and 24 hours after surgery were significantly different between two groups with p<0.05. Mann-Whitney test showed significant different results for the first time patient requiring morphine as rescue analgesia between gabapentin group (161.5 [25 – 990] minutes) and placebo group (67.5 [10 – 371] minutes) with p<0.001. Nausea events on gabapentin group was reported lower than placebo group. Conclusion. Gabapentin 600 mg orally is more effective than placebo as preemptive analgesia for nonobstetric lower abdominal surgery. Nausea events were reported lower when gabapentin given as preemptive analgesia."

"Latar Belakang: Penyuntikan obat anestesia spinal dosis tunggal diketahui menyebabkan hipotensi yang lebih besar dibandingkan dosis terbagi pada pasien obstetrik sehat, namun belum ada penelitian yang dilakukan pada pasien obsterik dengan penyulit hipertensi, khususnya di Indonesia. Hipotensi akibat anestesia spinal, khususnya pada pasien obstetrik dengan penyulit hipertensi, akan mengganggu kesejahteraan ibu dan janin. Tujuan: Membandingkan penurunan MAP dan kebutuhan efedrin, serta mengetahui level ketinggian blok antara teknik anestesia spinal dosis terbagi dengan dosis tunggal untuk bedah Sesar dengan penyulit hipertensi. Metode. Uji klinis acak tersamar tunggal terhadap 42 pasien di RSU Kabupaten Tangerang yang memenuhi kriteria dibagi menjadi dua kelompok. Kelompok dosis terbagi (TB) dilakukan dengan menyuntikkan 2/3 dosis (1,5 ml), dilanjutkan 1/3 dosis sisanya (1 ml) setelah jeda 90 detik. Kelompok dosis tunggal (TU) dilakukan dengan menyuntikkan seluruh dosis dalam sekali bolus. Keduanya dilakukan dalam posisi duduk, menggunakan kombinasi obat anestesia spinal bupivakain 0,5% hiperbarik 10 mg dan fentanil 25 mcg (volume total 2,5 ml), kecepatan 0,2 ml/detik, barbotase £0,1 ml sebelum penyuntikan, serta pemberian coloading cairan kristaloid 5-10 ml/KgBB. MAP diukur sebanyak 7 kali, dan kebutuhan efedrin serta ketinggian blok dicatat. Analisis hasil menggunakan uji General Linear Model (GLM) untuk pengukuran berulang, uji Fisher dan Mann-Whitney U. Hasil: Uji GLM menunjukkan tidak ada perbedaan bermakna antar waktu pengukuran antar kelompok (P >0,05), namun grafik garis menunjukkan trend MAP kelompok TB lebih tinggi pada 3 menit pertama dibandingkan kelompok TU. Penurunan MAP >20% terjadi lebih cepat pada kelompok TU (menit ke-3). Ketinggian blok sensorik keduanya terbanyak pada level T4 sebesar 11 subjek (52,4%) pada kelompok TB dan 9 subjek (42,9%) pada kelompok TU (P=0,59). Perbandingan dosis total pemakaian efedrin mendapat nilai median (range) kelompok TB sebesar 10 (0-25) mg dan kelompok TU sebesar 15 (0-30) mg (P=0,30). Simpulan: Penurunan MAP dan kebutuhan efedrin pada dosis terbagi tidak lebih kecil secara signifikan dibanding dosis tunggal, namun trend penurunan MAP >20% terjadi lebih lambat dan pemakaian efedrin lebih sedikit pada 3 menit pertama, dengan level ketinggian blok keduanya serupa.

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Background: Injection of a single bolus of local anesthetics in spinal anesthesia is known to cause greater hypotension than a fractionated dose in healthy obstetric patients, but no studies have been performed on obstetric patients with hypertensive complications, especially in Indonesia. Spinal hypotension will interfere to maternal and fetal well-being, particularly to mother with pregnancyinduced hypertension. Objective: Compare the decrease in mean arterial pressure (MAP) and ephedrin requirements, as well as to determine the level of sensory blockade between fractionated dose and single dose technique in spinal anesthesia for Cesarean section in pregnancy-induced hypertension. Methods: Single blinded randomized clinical trials of 42 patients at Tangerang District General Hospital who met the criteria were divided into two groups. The fractionated dose group (TB) was administered by injecting 2/3 of the total doses (1,5 ml) initially, followed by 1/3 of the remaining dose (1 ml) after 90 s. A Single dose group (TU) was performed by injecting all doses in one bolus. Both were performed in a sitting position, using a combination of 0,5% hyperbaric bupivacaine 10 mg and fentanyl 25 mcg (total volume of 2,5 ml), with velocities 0,2 ml/sec, £0,1 ml barbotage before injection, and administration of 5-10 ml/KgBW crystalloids for co-loading. MAP was measured 7 times, as well as ephedrine requirement and level of sensory blockade were recorded. Analysis was performed using a General Linear Model (GLM) test for repeated measurements, Fisher exact and Mann-Whitney U test. Results: The GLM test showed no significant differences between the time measurements between groups (P>0,05), but the line chart showed the TB group's trend of MAP was higher in the first 3 minutes than TU group. MAP decline >20% occured faster in TU group (minute-3). The level of sensory block was mostly at the T4 level of 11 subjects (52,4%) in TB group and 9 subjects (42,9%) in TU group (P = 0,59). The total dose of ephedrine requirement was in median (range) value of 10 (0-25) mg in TB group and 15 (0-30) mg in TU group (P = 0,30). Conclusion: MAP decline and ephedrine requirement in fractionated dose were not significantly smaller than single dose, but >20% decrease in MAP's trend occured more slowly and ephedrine requirement was less in the first 3 minutes, with similar level of sensory block in both groups."