Efektivitas Anestesi Umum Kombinasi Teknik Blok Skalp Menggunakan Levobupivakain 0,5 % terhadap Jumlah Fentanil Intraoperatif pada Pasien Kraniotomi Tumor Supratentorial di RSUP Dr. Sardjito

Background: High dose opioid has been clinically proven to provide effective blockage of stimuli during head incision but it has several unwanted side effects. Scalp block is an alternative modality which has been used as an adjunct to general anesthesia aimed to blunt stress response throughout craniotomy while maintaining more stable condition in terms of less hemodynamic fluctuation.

Objective: The study is aimed to compare fentanyl comsumption in general anesthesia combined with scalp block using saline and general anesthesia combined with scalp block using levobupivacaine 0.5% in patient which underwent craniotomy.
Method: Twenty patients suffered from intracranial tumor with age ranging from 18 - 65 years who underwent craniotomy tumor removal at RSUP Dr. Sardjito were divided into 2 treatment groups in which the Levobupivacaine 0.5% block group received general anesthesia with a combination of scalp blocks using Levobupivacaine 0.5% while the control group received general anesthesia with a combination of scalp blocks using saline. Patients with local anesthetic allergy and uncontrolled bleeding were excluded from data collection.

Result: The mean of fentanyl addition in patients with Levobupivacaine block was 513.0 mcg with a standard deviation of 164.2 mcg. Whereas in patients with Levobupivacaine block the average fentanyl addition was 1149.5 mcg with a standard deviation of 318.4 mcg. The mean difference in the addition of fentanyl between the two groups of 636.5 mcg showed a significant difference p = 0.001 (p <0.05).

Conclusion: Combination of scalp blocks using Levobupivacaine 0,5% with general anesthesia showed reduction of fentanyl consumption alongside with statistically insignificant hemodynamic fluctuation compared to general anesthesia and saline block in supratentorial brain tumor patient undergoing craniotomy. Hemodynamic profile in Levobupivacaine 0,5% group was maintained better than control group.

Latar belakang: Pengunaan opioid dosis besar terbukti efektif memblokade stimulasi pada insisi kepala namun memiliki efek yang tidak diinginkan. Blok skalp adalah salah satu modalitas alternatif yang dapat dikombinasikan dengan anestesi umum. Blok skalp dapat menumpulkan respon stres pada kraniotomi dan dapat mencegah gejolak hemodinamik yang tidak diinginkan.
Metode: Dua puluh orang pasien usia 18-65 tahun dengan tumor intrakranial yang menjalani tindakan kraniotomi tumor supratentorial di RSUP Dr. Sardjito dikelompokan menjadi 2 kelompok perlakuan dengan teknik anestesi umum kombinasi blok skalp menggunakan levobupivakain 0,5% dan pembiusan umum kombinasi blok skalp menggunakan salin. Pasien alergi lokal anestesi dan pendarahan tidak terkontrol termasuk kriteria eksklusi.
Hasil: Rerata penggunaan fentanil pada pasien dengan blok Levobupivakain sebesar 513,0 mcg dengan standar deviasi 164,2 mcg. Sedangkan pada pasien blok salin rerata penggunaan fentanil sebesar 1149,5 mcg dengan standar deviasi 318,4 mcg. Selisih rerata penggunaan fentanil antara kedua kelompok sebesar 636,5 mcg menunjukkan perbedaan yang bermakna p=0,001 (p<0,05).
Kesimpulan: Kombinasi anestesi umum dan blok skalp menggunakan levobupivakain 0,5% terbukti efektif mengurangi jumlah fentanil dibandingkan menggunakan larutan salin pada pasien tumor supratentorial yang menjalani kraniotomi. Fentanil terbukti menghasilkan fluktuasi hemodinamik tidak signifikan secara statistik dan mampu mempertahankan profil hemodinamik lebih baik dibandingkan dengan kelompok kontrol.