Blokade Saraf Femoral-Popliteal pada Pasien dengan Pseudarthrosis Kongenital Tibia yang Menjalani Prosedur Ilizarov Berulang

Danny Sandhi Arivianto, Mahendratama Purnama Adhi, Andri Lumban Tobing

Abstract


 

Latar belakang: Penggunaan blokade saraf perifer pada pasien pediatrik semakin meningkat karena dinilai aman, mengurangi kebutuhan opioid, efek samping minimal, pulih sadar lebih cepat dan mengurangi lama hari rawat. Untuk prosedur pembedahan ekstremitas bawah minimal diperlukan dua blokade saraf perifer.

Kasus: Kami laporkan dua kasus pasien pediatrik (4 dan 6 tahun) dengan pseudarthrosis kongenital tibia yang menjalani prosedur Ilizarov berulang. Manajemen anestesi dilakukan dengan kombinasi blokade saraf femoral-popliteal dengan levobupivacain 0,3% dan pasien disedasi dengan propofol 75 mcg/kgBB/menit selama intraoperasi. Kombinasi blokade saraf dilakukan dengan menggunakan stimulasi saraf perifer dengan bantuan pencitraan USG. Parameter yang dinilai ialah kekuatan efek analgetik dari blokade saraf perifer, pemberian analgetik tambahan serta efek samping kombinasi blokade saraf femoral-popliteal. Operasi berlangsung selama 2 jam dengan pemberian analgetik tambahan fentanyl intraoperasi sebanyak satu kali.

Kesimpulan: Kombinasi blokade saraf femoral-popliteal dapat menjadi teknik anestesi pilihan pada kasus pseudarthrosis kongenital tibia. Teknik tersebut memberikan hasil yang memuaskan, mengurangi penggunaan opioid dan tidak ada efek samping. Penambahan fentanyl intraoperatif kemungkinan disebabkan blokade saraf perifer yang tidak adekuat pada osteatom tibia karena penggunaan konsentrasi levobupivacain yang rendah.


Keywords


blokade saraf femoral-popliteal; levobupivacain; pseudarthrosis congenital tibia

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DOI: http://dx.doi.org/10.21776/ub.jap.2020.001.03.06

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