Perbedaan Efek Penambahan MgSO4 atau Fentanil terhadap Profil Anestesi Spinal dengan Lidokain 5%

Aria Windy Mahardhika, Sugeng Budi Santosa, Bambang Novianto Putro

Abstract


Pendahuluan: Anestesi spinal dengan lidokain memiliki lama kerja singkat. Penambahan MgSO4 atau Fentanil dapat memperpanjang durasi blokade sensorik maupun motorik dari lidokain. Penelitian ini bertujuan untuk menganalisis perbandingan efek penambahan MgSO4 atau Fentanil pada lidokain 5% terhadap mula kerja dan lama kerja blokade sensorik dan motorik dari anestesi spinal serta efek hemodinamiknya. Metode: Double Blind Randomized Control Trial pada 36 pasien ASA I dan II yang menjalani operasi dengan anestesi spinal. Pasien dibagi menjadi kelompok M (Lidokain Hiperbarik 75 mg+MgSO450 mg) dan kelompok F (Lidokain Hiperbarik 75 mg+Fentanil 25 μg). Mula kerja dan lama kerja blokade sensorik dan motorik, waktu mulai regresi sensorik, data hemodinamik serta efek samping dicatat. Hasil: Penambahan MgSO4 lebih efektif memanjangkan durasi blokade motorik (137,22 vs 116,11+19,75), p=0,014. Blokade sensorik pada penambahan MgSO4 juga lebih superior meskipun tidak bermakna. Pengaruh terhadap tanda vital dan efek samping tidak bermakna. Simpulan: Lama kerja blokade motorik Lidokain Hiperbarik lebih panjang pada penambahan MgSO4 dibandingkan penambahan Fentanil, mula kerja dan blokade sensorik tidak berbeda. Gejolak hemodinamik serta efek samping tidak berbeda bermakna antar kelompok.

 

Introduction: Spinal anesthesia with lidocaine has short duration of action. Addition of MgSO4 or Fentanyl can prolong duration of sensory and motor blockade of lidocaine. This study compared the effects of MgSO4 or Fentanyl addition to 5% Lidocaine on the onset of action, duration of sensory and motor blockade, and their hemodynamics effects. Methods: Double Blind Randomized Control Trial on 36 patients with ASA I and II who underwent surgery under spinal anesthesia. Patients were divided into group M (Hyperbaric Lidocaine 75 mg + MgSO4 50 mg) and group F (Hyperbaric Lidocaine 75 mg + Fentanyl 25 μg). Onset of action and duration of sensory and motor blockade, onset of sensory regression, hemodynamic data and side effects are recorded. Results: Duration of motor blockade was more prolonged with the addition of MgSO4 as compared with the addition Hyperbaric Lidocaine (137.22 vs 116.11 + 19.75), p = 0.014. Effect on sensory blockade was also superior but not significant. No significant effect on vital signs and side effects. Conclusion: Compared with the addition Hyperbaric Lidocaine, addition of MgSO4 to Hyperbaric Lidocaine prolonged the duration of motor blockade, but not the sensory blockade. Hemodynamic changes and side effects between groups are not significantly different.


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References


Do SH. Magnesium: A versatile drug for anesthesiologist. Kor J Anesthesiol. 2013. 65(1):4-8

Arcioni R, Palmisani S, Santorsola C, Sauli V, Romano S, Mercieri M, et aL.Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post-operative analgesic requirements: A prospective, randomized, double-blind, controlled trial in patients undergoing major orthopedic surgery. Acta Anaesthesiol Scand. 2007. 51:482-9

Butterworth J, Mackey DC. Spinal, epidural and caudal blocks. Dalam: Morgan GE, Mikhail MS, eds. Clinical Anesthesiology 6th ed. New York: McGraw Hill Co, 2013.pp. 937-74

Elrahman TNA, Youssry MA. The impact of single low dose IV magnesium sulphate adjuvant to ultrasound guided transerses abdominis plain block for control of postcaesarean pain. Open J Obstetr Gynecol. 2017;7:269-80

Edgcombe H, Hocking G. Local Anaesthetic Pharmacology. Anaesthesia UK: Oxford; 2009

Malleswaran S, Panda N, Mathew P, Bagga R. A randomized study of Magnesium sulphate as an adjuvant to intrathecal bupivacaine in patients with mild preeclampsia undergoing Caesarean section. Internat J Obstetr Anesth.2010;19: 161-66

Morrison AP, Hunter JM, Halpem SH, Banerjee A. Effect of intrathecal magnesium in the presence or absence of local anaesthetic with and without lipophilic opioids: a systematic review and meta-analysis. Br J Anaesth. 2013;110 (5): 702-12

Shukla D, Verma A, Agarwal A, Pandey HD, Tyagi C. Comparative study of intrathecal dexmedetomidine with intrathecal magnesium sulfate use as adjuvants to bupivacain. J Anesthesiol Clin Pharmacol. 2011;27(4):495-99

Miller RD. Miller’s Anesthesia 7th ed. San Fransisco: Churchill Livingstone; 2010.

Vasure R, Ashahiya ID, Mahendra R, Narang N, Bansal RK. Comparison of effect of adding intrathecal magnesium sulfate to bupivacaine alone and bupivacaine-fentanil combination during lower limborthopedic surgery. Internat J Scient Study. 2016;3(10): 141-46

Ancorn C, Casey WF. Spinal anaesthesia: a practical guide. Gloucestershire Royal Hospital: UK. 2010.

Barash PG, Cullen BF, Stoelting RK. Clinical Anesthesia 7th ed. Philadelphia: Lippincott William &Willkins, 2013.pp. 532 – 47

Clark MA, Harvey RA, Finkel R, Rey JA, Whalen K. Pharmacology. Lippincott Williams & Wilkins, 2011. p 175.

Morgan GE, Mikhail MS, Murray MJ. Clinical Anesthesiology 6thed. New York: Lange Medical Books/McGraw Hill Medical Pub. Div, 2013.

Pasero C, McCaffery M. Pain Assesment and Pharmacologic Management. Elsevier Health Sci. 2011.

Samir EM, Badawy SS, Hassan AR. Intrathecal vs intravenous magnesium as an adjuvant to bupivacaine spinal anesthesia for total hip arthroplasty. Egypt J Anesth. 2013;29(4):395-400

Singh RK, Vaibhaw V, Hasnat S. Comparative study of dexmedetomidine and magnesium sulphate as an adjuvant to bupivacaine in spinal anesthesia. J Evidence based Med Healthcare 2015;2(35): 5438-46

Stoelting RK, Hillier SC. Local Anesthetics. Dalam: Pharmacology and Physiology in Anesthetic Practice 5th ed. Philadelphia: JB Lippincott Co., 2015. pp 179-265.

Trellakis S, Lautermann J, Lehnerdt G. Lidocaine: neurobiological targets and effects on the auditory system. Elsevier.2007;166: 303-22

Staikou C, Paraskeva A. The effect of intrathecal and systemic adjuvants on subarachnoid block. Minerva Medica2013( cited 2014 )


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