Penanganan nyeri pada pasien anak merupakan tantangan yang cukup besar bagi dokter spesialis anestesi. Blokade kaudal merupakan salah satu teknik anestesi regional yang mudah dan sangat efektif ...sebagai analgetik pada anak yang menjalani operasi di bawah umbilikus. Data yang diperoleh dari Inggris dan Irlandia selama bulan April sampai dengan Juni 2008 menunjukkan bahwa penggunaan blokade kaudal masih rendah ( 61% ). Tujuan penelitian ini adalah mengetahui penggunaan, obat, teknik, dan masalah yang dihadapi pada blokade kaudal di Kota Bandung. Penelitian dilakukan selama bulan Maret hingga April 2018. Penelitian ini bersifat deskriptif dengan menggunakan kuesioner yang diberikan kepada 70 dokter spesialis anestesi di kota Bandung yang direspons oleh 64 orang (78%) dengan mengembalikan kuesioner. Dari penelitian ini didapatkan dokter spesialis anestesi yang melakukan blokade kaudal pada tahun 2016 sebesar 55%. Blokade kaudal digunakan untuk kombinasi anestesi dan analgesik pascaoperasi pada 62% responden. Teknik yang digunakan dalam blokade kaudal ini adalah blind technique tanpa alat bantu. Obat yang paling sering digunakan adalah bupivakain (91%). Permasalahan yang dihadapi di Kota Bandung yang mengakibatkan rendahnya penggunaan blokade kaudal adalah keterbatasan waktu tindakan (20%) dan ketersediaan obat dan alat (23%). Kata kunci: Blokade kaudal, bupivakain, teknik buta Overview on Usage, Drug, Technique and Problems on Caudal Blockade Procedure in Bandung City on 2016 Pediatric pain management in pediatric is a big challenge for anesthesiologists. The caudal blockade is one of the easy and highly effective analgesic approaches for surgical procedure below umbilicus in children. Data from Ireland and United Kingdom show that the application of caudal blockade is relatively low (61%). The aim of this study was to explore the drug, technique, and challenges faced in caudal blockade application in Bandung City. This study was conducted from March to April 2018. This was a descriptive study using a questionnaire distributed to 70 anesthesiologist in Bandung city. The response rate was 77.65% (64 persons). This study found that 59.09% anesthesiologist had performed caudal block during 2016 which was used for anesthesia and post-operative analgesics by 61,54% respondents. Blind technique was used in this procedure without using additional equipment. The most frequently used was bupivacaine (97.44%). The low application of caudal block in Bandung during 2016 was caused by the limited time for the procedure (23.44%) and the availability of drug and equipment (23.44%). Key words: Caudal block, Bupivacaine, Blind technique
Latar Belakang : Bupivakain hiperbarik merupakan agen anestesi lokal yang saat ini paling sering digunakan untuk anestesi spinal pada pembedahan seksio sesarea.Namun disebutkan memiliki efek samping ...yang buruk terhadap sistem kardiovaskuler dan susunan saraf pusat.Levobupivakain merupakan salah satu obat anestesi yang merupakan enansiomer murni bupivakain rasemik, benar-benar isobarik terhadap cairan serebrospinal wanita hamil dan memiliki sifat kurang toksik bagi jantung dan susunan saraf pusat. Tujuan : Penelitian ini bertujuan untuk membandingkan onset dan durasi blok sensorik dan blok motorik serta efek samping yang terjadi pada penggunaan Bupivakain hiperbarik dan Levobupivakain isobarik pada seksio sesarea. Subyek dan metode : Penelitian ini merupakan penelitian eksperimental dengan memakai uji klinis tersamar tunggal. Subyek penelitian ditentukan dengan cara consecutive sampling yang memenuhi kriteria inklusi dan eksklusi. Subyek dibagi ke dalam dua kelompok, 43 subyek pada kelompok Bupivakain Hiperbarik 10 mg (BH) dan 43 subyek pada kelompok Levobupivakain Isobarik 10 mg (LI). Pada kedua kelompok dibandingkan onset dan durasi blok sensorik dan motorik, kejadian hipotensi, menggigil, bradikardia dan mual muntah. Uji statistik perbandingan rerata antar kedua kelompok dilakukan dengan uji Mann Whitney.
Latar Belakang: Persalinan dengan seksio sesarea sangat umum dilakukan dan setiap intervensi yang dapat mengurangi rasa sakit pasca operasi layak diteliti lebih lanjut. Cara terbaik untuk mengurangi ...rasa sakit dengan memberikan analgesi yang langsung bekerja pada area luka. Telah diketahui morfin memiliki reseptor perifer sehingga pemberian secara subkutan dapat menjadi metode yang sangat efektif dalam manajemen nyeri pasca operasi Tujuan: Membandingkan efek analgesi dari infiltrasi lokal morfin 10 mg dengan bupivakain 2mg/kgBB 0,5% pada pasca seksio sesarea dengan anestesi spinal. Subjek dan Metode: Penelitian ini adalah uji klinis acak tersamar ganda dengan 100 sampel wanita hamil, usia 20-40 tahun, PS-ASA I-II yang akan menjalani seksio sesarea elektif dan darurat dengan anestesi spinal. Setelah dihitung secara statistik, sampel dibagi secara acak menjadi 2 kelompok. Kelompok pertama mendapat morfin 10 mg dan kelompok kedua mendapat bupivakain 0,5% 2 mg/kgBB secara infiltrasi lokal subkutan didaerah luka operasi. Skala nyeri dinilai dengan VAS. Hasilnya diuji dengan uji T-independent, Chi-Square, dengan nilai signifikan 95% (p <0,05%, signifikan secara statistik). Hasil: Pada kelompok morfin pemberian analgesi tambahan lebih sedikit daripada kelompok bupivakain, hasilnya berbeda bermakna secara statistik (p <0.05) pada setiap jam pengamatan. Efek samping tidak ditemukan pada kedua kelompok. Kelompok morfin meringankan rasa sakit lebih baik daripada kelompok bupivakain dengan skor VAS yang lebih rendah pada setiap jam pengamatan Simpulan: Infiltrasi lokal subkutan 10 mg morfin memberikan efek analgetik yang lebih baik pada pasien pasca seksio sesarea dengan anestesi spinal dibandingkan dengan bupivacain 0,5% 2 mg/kgBB, tanpa efek samping. Comparison of the Analgesic Effects of 10 mg Morphine and 2mg/BW Bupivacaine 0.5% Infiltration in Cesarean Section with Spinal Anesthesia Technique Abstract Background: Nowadays, deliveries by cesarean section are more commonly done, any intervention that can make progression to reduce post-operative pain are feasible for further study. The best way to reduce pain is by administration pain relieve drug that directly act in wound. It is known that morphine has peripheral receptors, so subcutaneous administration can be a very effective method of postoperative pain management. Objective: To compare analgetic effect from local infiltration of 10 mg morphine with 2mg/BW bupivacaine 0.5% in post cesarean section with spinal anesthesia Subject and Methods: This study was done by double blinded randomized clinical trial with 100 samples of pregnant women, age 20-40 years, PS-ASA I-II that will undergo elective and emergency cesarean section with spinal anesthesia. After calculated statistically, all samples divided randomly into 2 groups. First group got morphine 10 mg and second group got bupivacaine 0.5% 2 mg/BW infiltration at the area of surgical wound. Pain scale was evaluated by VAS. The result was tested by T-independent test, Chi-Square, with significant value 95% (p<0.05%, statistically significant). Result: In morphine group, the additional analgesia was less than bupivacaine group, the results were statistically significant (p <0.05) at each hour of observation. No side effects were found in either group. The morphine group relieved pain better than the bupivacaine group with lower VAS scores at each hour of observation. Conclusion: Infiltration of 10 mg morphine subcutaneous compared to bupivacaine 0.5% 2mg/BW give better analgetic effect in post cesarean section patients with spinal anesthesia, without any side effects
Berbagai macam analgetik dapat diberikan untuk mengatasi nyeri pascaoperasi mastektomi, namun tidak ada yang ideal dalam menangani nyeri pascaoperasi. Teknik pemberian topikal adalah teknik terbaru ...untuk penanganan nyeri akut pascaoperasi modified radical mastectomy. Penelitian ini bertujuan membandingkan waktu bebas nyeri dan jumlah kebutuhan opioid pascaoperasi modified radical mastectomy. Penelitian menggunakan metode uji klinis acak terkontrol buta ganda melibatkan 38 pasien yang menjalani operasi modified radical mastectomy di RSUP Dr. Hasan Sadikin Bandung pada bulan November 2019–Februari 2020. Pasien dibagi menjadi dua kelompok, kelompok morfin 15 mg topikal (kelompok M, n=19) dan kelompok bupivakain 0,25% topikal (kelompok B, n=19). Analisis data menggunakan Uji Mann Whitney karena distribusi data tidak normal berdasar hasil Uji Shapiro-Wilk. Hasil penelitian didapatkan bahwa waktu bebas nyeri lebih lama pada kelompok M (846,78±411,80 menit) dibanding dengan kelompok B (401,52±123,19 menit) dengan perbedaan yang signifikan (p<0,05). Total kebutuhan opioid kelompok M lebih sedikit, yaitu sebesar 1,15±0,60 gram dibanding dengan kelompok B sebesar 3,84±0,89 gram dengan perbedaan yang signifikan (p<0,05). Simpulan penelitian adalah pemberian morfin topikal memberikan waktu bebas nyeri lebih lama dan jumlah kebutuhan opioid pascaoperasi lebih sedikit dibanding dengan pemberian bupivakain topikal untuk nyeri pascaoperasi modified radical mastectomy.
Amaç: Bu in vitro çalışmada uzun etkili ve potent bir lokal anestezik olan bupivakainin endotelli ve endotelsiz dana kardiyak ven düz kası üzerine etkileri araştırılmıştır.Gereç ve Yöntem: Dana ...kardiyak ven halkaları %95 O2 ve %5 CO2 ile gazlandırılan ve sıcaklığı 37°C’de sabit tutulan KHS içeren izole organ banyolarına alındı. Uygulanan ajanlara verilen yanıtlar izometrik olarak kaydedildi.Bulgular: Bupivakain 10-8 – 10-4 M endotelli ve endotelsiz ven halkalarının bazal tonusunu etkilemedi. 5-HT 10-5 M ile maksimum kasılma cevabı alındıktan uygulanan bupivakain düşük konsantrasyonlarda 10-8 – 10-6 M kasılma cevaplarını anlamlı olarak azalttı, yüksek konsantrasyonlarda 10-5 – 10-4 M ise kardiyak ven halkalarında kasılma gözlendi. 10-4 M bupivakain ilavesinden sonra oluşan maksimum kasılma 5-HT ile elde edilen maksimum kasılma cevabına benzerdi. Dokuların L-NAME 10-3 M ile inkübasyonu bupivakainin düşük konsantrasyonlarında oluşan gevşeme cevaplarını inhibe etti; 10-5 ve 10-4 M bupivakain varlığında ise ven halkalarının kasılma cevapları kontrol 5-HT kasılmalarına göre anlamlı olarak yüksekti. İndometazinle 10-5 M inkübe edilen dokularda 10-8 – 10-6 M aralığında verilen bupivakain, kontrol dokulardakine benzer şekilde, doza bağlı olarak artan gevşeme cevapları oluşturdu. Bupivakainin yüksek dozlarında gözlenen kasılma cevapları ise indometazin varlığında inhibe edildi. Endotelsiz ven halkalarında ise banyoya bupivakain ilavesi 10-8 – 10-6 M 5-HT’ye bağlı maksimum kasılma cevaplarını değiştirmedi Sonuç: Bulgularımız; dana kardiyak veninde bupivakainin bazal tonusunu etkilemediğini, 5-HT ile önkasılma yapılan dokularda ise gevşeme ve kasılma tarzında bifazik cevap oluşturduğunu endotelden salıverilen NO’in bupivakainin gevşetici etkilerinde, sikloooksijenaz ürünlerinin ise kasıcı etkilerinde rol oynadığını göstermektedir
Penggunaan anestesi spinal untuk operasi besar saat ini umum dilakukan dan telah dipraktikkan dalam jangka waktu cukup lama. Parasetamol merupakan obat analgetik yang telah dikenal cukup lama dan ...saat ini digunakan untuk mengontrol nyeri baik selama operasi maupun pascaoperasi. Parasetamol memiliki efek analgetik pada susunan saraf pusat (SSP) melalui penghambatan jalur siklo-oksigenase dan berpengaruh secara tidak langsung terhadap sistem serotoninergik serta ditemukan dalam konsentrasi yang signifikan dalam cairan serebrospinal setelah pemberian melalui infus. Penelitian ini bertujuan mengevaluasi pengaruh pemberian parasetamol intravena dosis tunggal sebelum operasi terhadap regresi blok anestesi spinal pada pasien yang akan dilakukan operasi besar. Sebanyak 30 pasien dengan klasifikasi American Society of Anesthesiologist (ASA) I dan II dengan rentang usia 18–55 tahun yang dilakukan operasi besar dengan anestesi spinal diikutsertakan ke dalam uji acak terkontrol buta ganda yang dilakukan periode Februari–Juni 2015 di Operating Theatre-East Avenue Medical Center, Quezon City, Philippines. Pasien dialokasikan menjadi 2 grup secara acak dan diberikan infus 100 mL parasetamol 1 gram (Grup A; n=15) atau 100 mL NaCl 0,9% (Grup P; n=15) selama 20 menit sebelum pemberian obat pada anestesi spinal. Penilaian nyeri dinilai menggunakan visual analog scale (VAS), serta dicatat pada saat diberikan bantuan obat analgetik. Data dianalisis dengan uji chi-kuadrat dengan nilai p<0,05 dianggap bermakna. Regresi blok sensorik tertunda secara signifikan pada Grup A pada jam ke-2 (T5–T7; n=11) dibanding dengan grup P pada jam ke-2 (T5–T7; n=2) dengan nilai p<0,05. Simpulan, pemberian infus parasetamol intravena 20 menit sebelum dilakukan anestesi spinal dengan bupivakain hiperbarik 0,5% dapat menunda regresi blok sensorik. Kata kunci: Anestesi spinal, bupivakain hiperbarik, parasetamol intravena, regresi sensorik Effect of Intravenous Paracetamol on Sensory Regression of Spinal Anesthesia with Bupivacaine Heavy 0.5% Spinal anesthesia is a long-accepted anesthesia that is commonly used for major surgery. Paracetamol intravenous infusion is a known analgesics that is recently used for intra-operative as well as post-operative pain control. Paracetamol has an analgesic effect, primarily to the central nervous system (CNS), through the cyclooxygenase pathway, and probably has an indirect influence on the serotoninergic system which is supported by the fact that paracetamol is found in significant concentration in the cerebrospinal fluid (CSF) after infusion. This study was designed to evaluate the effect of single pre-operative intravenous infusion of paracetamol on sensory regression of spinal blockade in patients undergoing major surgery. Thirty ASA I and II patients aged 18–55 years undergoing major surgery under spinal anesthesia were included in this randomized controlled trial double blind study during the period of February–June 2015 at the Operating Theatre – East Avenue Medical Center, Philippines. Patients were randomly allocated to receive either 1 gr/100 mL Paracetamol (Group A; n=15) or 100 mL Normal Saline (Group P; n=15) drip for 20 minutes before administration of spinal anesthesia. The intensity of pain was assessed by Visual Analog Scale (VAS) Score. Time of rescue analgesic administration was also recorded. Data were analyzed by Chi-Square Test with p value of <0.05 considered significant. Sensory regression was delayed in Group A (T5-T7; n=11) when compared to Group P (T5 – T7; n=2), which was statistically significant (p<0.05). Therefore, the administration intravenous Paracetamol 20 minutes prior to spinal anesthesia administration with Bupivacaine Heavy 0.5% can delay regression of sensory blockade. Keywords: Bupivacaine heavy, intravenous paracetamol, sensory regression, spinal anesthesia
Blokade kaudal merupakan salah satu blokade regional yang digunakan pada pediatrik. Teknik ini digunakan sebagai tata laksana nyeri pascaoperasi urogenital, rektal, inguinal, dan operasi ekstremitas ...bawah. Penelitian ini bertujuan mengetahui perbandingan waktu kebutuhan analgesik pascaoperasi hipospadia pada blokade kaudal bupivakain 0,25% dengan kombinasi bupivakain 0,25% dan klonidin 1 µg/kgBB. Penelitian menggunakan uji klinis acak terkontrol buta tunggal dilakukan di Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung bulan November 2017 sampai Januari 2018. Pasien dibagi menjadi grup bupivakain 0,25% (grup B, n=15) dan grup kombinasi bupivakain 0,25% klonidin 1 µg/kgBB (grup BK, n=15). Uji statistik menggunakan uji-t tidak berpasangan dan Uji Mann-Whitney. Hasil penelitian mengungkapkan waktu kebutuhan analgesik pertama lebih lama pada grup BK (766,46±75,34 menit) dibanding dengan grup B (344,4±59,46 menit) dengan perbedaan signifikan (p<0,05). Simpulan, kombinasi bupivakain 0,25% dan klonidin 1 µg/kgBB pada blokade kaudal menghasilkan waktu kebutuhan analgesik pertama lebih lama dibanding dengan bupivakain 0,25% pascaoperasi hipospadia. Kata kunci: Blokade kaudal, bupivakain, hipospadia, klonidin, waktu kebutuhan analgesik
Amaç: Laparoskopik kolesistektomi sonrası ağrının, açık kolesistektomiden daha az yoğun olduğu, cerrahi sonrası ya da ameliyat sonrası gece boyunca ilk birkaç saat özellikle öksürük, solunum ...hareketleri ve mobilizasyonun bazı hastalarda halen önemli bir rahatsızlık olduğu görüldü. Materyal ve Metod: Çalışma laparoskopik kolesistektomi olan 200 hastayı içerdi. Her biri 100 hasta olan 2 gruba ayrıldı. Tamamlama pf laparoskopik kolesistektomi sonrası ilk gruba (deney grubu) bupivakain ve diğer gruba (kontrol grubu) 30 ml serum fizyolojik verildi. Bulgular: Kurtarma analjezi gereksiniminin ortalama süresi deney grubunda 8,5 saatken, kontrol grubunda bu süre 7,29 saattir. Deney grubunda diklofenakın toplam tüketimi 95mg iken, kontrollerde 108.75 mg'dır (p=0.246). Deney grubunda tramadolun toplam tüketimi 50mg, kontrol grubunda 130mg'dır (p<0.05). Ameliyat sonrası karın ağrısıyla birlikte omuz ucu ağrısı tüm zaman aralıklarında (4 saat, 12 saat, 24 saat) kontrollerle karşılaştırıldı. Deney grubunda ağrı daha azdı. Ameliyat sonrası dönemde deney grubunda sadece 2 hastada bradikardi ve 1 hastada hafif uyuşukluk gelişti. Bu 3 hastanın sadece 3-4 saat sürekli izlenmesi istendi. Hastanede ortalama yatış kontrollerde 1.93 gün iken, deneylerde 1.71 gündü. Sonuç: İntraperitoneal ve port alanı bupivakain, laparoskopik kolesistektomi ameliyatı sonrası dönemde ağrının somatik ve visseral bileşenlerini azaltır. Bu, kurtarma analjezi gereksinimini ve hastanın hastaneden taburcu olma hızını azaltır.
Objective: Ilioinguinal/iliohypogastric (II/IH) nerve block added to general anesthesia is frequently used for postoperative analgesia in pediatric patients. We aimed to compare the postoperative ...analgesic effects of bupivacaine and levobupivacaine for II/IH nerve block for inguinal hernia repair in pediatric patients, which is not investigated previously.Materials and Methods: In this 2-year retrospective study, data were collected from the medical charts of patients that underwent unilateral inguinal hernia repair. Patients were included who received an II/IH nerve block with 0.2 mL/kg 0.5% of either bupivacaine (Group B) or levobupivacaine (Group L). Non-elective cases, age under 2 years and patients with multiple procedures were excluded. Demographic properties of the patients (age, weight, and sex), duration and side of surgery, pain scores, additional analgesic requirement and complications were documented. The chi-square test and the Mann-Whitney U test were used for statistical analysis. Results: In both groups, the pain scores were not significantly different at post anesthesia care unit, 1, 2, 6 and 24th hours; nevertheless, the pain scores at 4th hour were significantly lower in Group L. Conclusion: II/IH nerve block added to general anesthesia is effective in inguinal region surgery of pediatric patients in postoperative pain control, and 0.5% levobupivacaine and bupivacaine had similar analgesic effect.
Lokal anestezikler anestezik ve postoperatif analjezik olarak sıkça kullanılmaktadırlar. Bupivakain en sık kullanılan amid grubu lokal anestezik maddelerden biridir. Amid grubu lokal anesteziklerin ...santral sinir sistem(SSS)’de depresyon, nöbet ve bilinç değişikliğine neden olurken kardiyovaskuler sistem (KVS)’de aritmilere yol açmaktadır. Spinal lokal anesteziklerin nörolojik komplikasyonların nedenleri ilacın yüksek dozda verilmesi, hızla sistemik dolaşıma geçmesi, yanlışlıkla İV verilmesi ya da ilacın sefale doğru yayılmasıdır. Bizim olgumuzda intratekal bupivakain kullanıldı. İntratekal bupivakain kullanımına bağlı jeneralize myoklonik nöbet bildirilmişitir. Ancak araştırmalarımıza göre intratekal bupivakain kullanıma bağlı Jeneralize tonik klonik (JTK) tarzda status epileptikus olgusu bildirilmemiştir. Olgumuz intratekal bupivakain kullanım sonrası gelişen JTK tarzda status epileptikus vakası olması nedeni ile sunuldu
Local anesthetics are commonly used as analgesics and anesthetics. Local anesthetics from the amide group may lead to symptoms of the central nervous system (CNS) such as depression, seizures or altered mental state, while they may lead to arrhythmia in the cardiovascular system (CVS). The causes of the neurologic complications observed with spinal local anesthetics are the administration of high doses, rapid entry into the systemic circulation, erroneous administration through the IV route, or the diffusion of the drug towards the cephalic region. Bupivacaine is among the most commonly used local anesthetics from the amide group. However rare, neurological injury after administered bupivacaine can be distressing to patients and their families. In our patient, we have administered bupivacaine through the intrathecal route. Thus, we would like to present a case where status epilepticus in the form of generalised tonic-clonic seizures (GTC) has developed subsequent to the intrathecal administration of bupivacaine. J Clin Exp Invest 2014; 5 (1): 108-111
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