Efek Parasetamol Intravena terhadap Regresi Sensorik Anestesi Spinal dengan Bupivakain Hiperbarik 0,5%

Abstract

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