Efek Blok Transversus Abdominis Plane Teknik Landmark Terhadap Kebutuhan Analgetik Pascabedah Herniorafi
ABSTRACT

Background: The transversus abdominis plane block is a safe, easy, and effective technique to provide the postoperative analgesia in surgery involving the anterior abdominal wall.

Objective: To assess the effect of TAP block landmark technique on the analgesic requirement postoperative herniorrhaphy.

Methods:  This is a single blind clinical trial. This study was conducted on 44 male patients, aged between 18 and 60 years, with the ASA physical status of I-II, and the IMT of 18-24, and undergoing the elective herniorrhaphy surgery with the spinal anesthesia. The subjects were divided in two groups: the TAP group (n = 22) who received the TAP block of 20 ml of bupivacaine 0.25 % plus the epinephrine of 1:200.000 after completing the surgery, and the control group (n = 22) who did not receive the TAP block. All the patients received 15 mg of meloxicam suppositories and tramadol of 0.1 mg/kg via continous infusion at the end of the surgery. The pain assessment was done using the Numeric Rating Scale ( NRS ), and when the NRS reached 4, the fentanyl 0.5 mcg/kg was given as a rescue. The first rescue time and the total fentanyl requirement for 24 hours after the surgery was recorded.

Results:. The research results revealed that the first rescue time was longer in the TAP group compared to the control group (17.81 ± 7.62 compared to 9.15 ± 8.12 hours; p<0.0001). The total fentanyl required in 24 hour period was less in the TAP group compared to the control group (9.21 ± 13.59 vs. 30.88 ± 20.39 mcg; p=0.02).

Conclusion: The TAP block as a component of a multimodal analgesic regimen provides a longer analgesia compared to control and has a high opioid sparing effect

Keywords : herniorrhaphy, landmark technique, TAP block .
ABSTRAK

Latar Belakang: Blok transversus abdominis plane (TAP) adalah teknik yang aman, mudah, dan efektif untuk memberikan analgesia pascabedah pada operasi yang melibatkan dinding anterior abdomen.

Obyektif: Menilai  efek blok TAP teknik landmark terhadap kebutuhan analgetik pascabedah herniorafi.

Metode: Penelitian ini merupakan uji klinik tersamar tunggal. Penelitian dilakukan pada 44 pasien laki-laki, usia 18-60 tahun, status fisik ASA I-II, dan IMT 18-24 yang menjalani operasi herniorafi elektif dengan anestesi spinal. Pasien dibagi menjadi kelompok TAP  (n=22) yang mendapatkan blok TAP dengan bupivakain 0,25% 20 ml ditambahkan epinefrin 1:200.000  setelah operasi selesai; dan kelompok kontrol (n=22) yang tidak mendapatkan blok TAP. Semua pasien diberikan  meloksikam suppositoria 15 mg dan tramadol 0,1 mg/kgBB/infus kontinyu pada akhir operasi. Penilaian skala nyeri menggunakan Numeric Rating Scale (NRS), bila NRS mencapai 4 diberikan rescue fentanil 0,5 mcg/kgBB; waktu rescue pertama dan kebutuhan total fentanil selama 24 jam pascabedah dicatat.

Hasil: Waktu rescue pertama lebih panjang pada kelompok TAP  dibandingkan dengan kelompok kontrol (17,81 ± 7,62 berbanding 9,15 ± 8,12 jam; p<0,001). Kebutuhan total fentanil dalam 24 jam lebih sedikit pada kelompok TAP  dibandingkan dengan kelompok kontrol (9,21 ± 13,59 berbanding 30,88 ± 20,39 mcg; p=0,02).

Simpulan: Sehingga dari penelitian ini disimpulkan bahwa blok TAP sebagai komponen rejimen analgesia multimodal memberikan analgesia yang efektif  dengan durasi analgesia lebih panjang dibanding kontrol dan memiliki opioid sparing effect yang tinggi.

 

Kata kunci : Blok TAP, herniorafi, teknik landmark
Artikel Sekarang
Dipublikasi pada 01 July 2015
Penulis :
» Nur Asdarina
» Syamsul Hilal Salam
» A Husni Tanra
Kategori : Penelitian
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Dari Jurnal
Volume VII Nomor 2, Juli 2015 Cover JAI
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