PERUBAHAN LAMA ANALGESI BLOK SUBARAKHNOID LIDOKAIN 50/0 HIPERBARIK DENGAN PREMEDIKASI VERAPAMIL ORAL

Abstract

Background: Subarachnoid block using hyperbaric lidocaine is a popular method for brief surgical procedure and has been used widely for patients with certain medical conditions. Nevertheless, the use of hyperbaric lidocaine 5% . for subarachnoid block has its limitation concerning- the duration of analgesia. An effort to increase duration of analgesia has been done throtigh interaction mechanism between two drugs on the sinap transmission block of spinal cord. Verapamil is a calcium channel blocker drug with important role in pain physiology at spinal cord level through the blockade of normal ,sensory process and the prevention of central sensitization Interaction between verapamil and lidocaine can inhibit neuron excitability at ionic channel level. Objective: To find objective evidence of SO mg verapamil as premedication to lengthen the duration of analgesia on subarachnoid block with hyperbarie lidocaine 5%. Patients and methods : This study is a pure experimental study with level 2 phases 3 clinical trials randomly double blinded and post test only control group design, conducted in Central Operating Theatre of Karyadi General Hospital Semarang from July to October 2000. The 'subjects of this study are 40 patients ASA I-II, aged between 18-60 years old with elective surgery on lower abdominal area, perineum and lower extremity who fulfilled inclusion criteria for subarachniod block. Patients were divided into two groups, control group received only hyperbaric lidocaine 5% and experimental group received hyperbaric lidocaine 5% with 80 mg verapamil orally as a premedication. Two segment regression time was determined between two groups. Results: Duration of analgesia in the experimental group received hyperbaric lidocaine 5% with 80 mg verapamil orally as a premedication is significantly longer (p = 0,034) compared to control group. Conclusion: 80 mg verapamil orally as a premedication on subaraclmoid block using hyperbaric lidocaine 5% made longer duration of analgesia compared to subarachnoid block with hyperbaric lidocaine 5 % only. Latar belakang: Blok subarakhnoid dengan rnenggunakan lidokain hiperbarik telah populer untuk prosedur operasi singkat dan telah digunakan secara luas untuk pasien dengan berbagai kondisi klinik tertentu. Namun penggunaan lidokain 5% hiperbarik untuk blok subarakhnoid mernpunyai keterbatasan dalam lama analgesi. Usaha untuk menambah lama analgesi telah dilakukan melalui mekanisme interaksi antara dua obat dala• menghambat transmisi sinap pada medulla spinalis. Verapamil merupakan obat penghambat kanal kalsium yang rnempunyai peranan penting dalam fisiologi nyeri pada tingkat medulla spinalis melalui pengharnbat proses sensori dalam fisiologi nyeri pada tingkat medulla spinalis melalui penghambatan proses sensoris, normal serta pencegahan sensitisasi sentral. Interaksi antara veraparnil dan lidokain dapat menghambat eksitabilitas neuron pada tingkat kanal ionilc. Tujuan: mencari bukti obyektif apakah premedikasi verapamil 80 mg per oral dapat memperpanjang lama analgesi pada blok sabarakhnoid dengan lidokain 5% hiperbarilc. Pasien dan metoda: Penelitian eksperimental murni berupd uji klinik tahap 2 fase III dan dilakukan secara acak tersamar ganda, dengan rancangan post test only control group design, dilakukan di kamar bedah RS. Dr. Kariadi Semarang, periode Juli Olctober 2000. Subyek penelitian adalah 40 penderita ASA I-II, 18-60 tahun, program elektif daerah abdomen bawah, perineum dan ekstremitas bawah yang memenuhi kriteria inklusi blok subarakhnoid. Penderita dibagi menjadi 2 kelompok yaitu kelompok Icontrol dengan lidokain 5% hiperbaiik dan kelcmpok perlakuan dengan penambahan premedikasi verapamil 80 mg per oral. Waktu regresi 2 segmen ditentukan antara kedua kelompok. Hasil: Lama analgesi dengan penambahan premedikasi verapamil 80 mg per oral pada blok subrakhnoid lidokain 5% hiPerbarik lebih lama secara bermakna (p = 0,034) dibandingkan kelompok kontrol. Kesimpulan: Penambahan premedikasi veraparnil 80 mg per oral dapat meniperpanjang lama analgesi blok subarakhnoid dengan lidokain 5% hiperbark