Perbandingan Insidensi Post Dural Puncture Headache (PDPH) Pascaseksio Sesarea Dengan Anestesi Spinal Antara Tirah Baring 24 Jam Dengan Mobilisasi Dini

Mohamad Andy Prihartono, Ezra Oktaliansah, A. Himendra Wargahadibrata

Abstract


Post Dural Puncture Headache (PDPH) merupakan salahsatu komplikasi iatrogenik dari anestesi spinal. Patofisiologi PDPH sampai saat ini belum jelas, namun teori yang selama ini dianut akibat penurunan volume dan tekanan CSS (Cairan SerebroSpinal). Penelitian terdahulu menyatakan PDPH dapat dicegah dengan tirah baring selama 24 jam. Beberapa penelitian terbaru membuktikan mobilisasi dini tidak meningkatkan resiko PDPH. Tujuan penelitian ini untuk membuktikan bahwa tidak ada perbedaan insidensi PDPH pada pasien yang dilakukan tirah baring selama 24 jam dengan mobilisasi dini segera setelah fungsi motorik pulih.Penelitian dilakukan dengan tipe quasi experimental dan rancangan rangkaian waktu dengan pembanding. Penelitian melibatkan 200 wanita hamil berumur 18-30 tahun, yang akan dilakukan seksio sesarea dengan anestesi spinal, kemudian dibedakan dalam dua kelompok masing-masing 100 orang. Kelompok pertama dilakukan mobilisasi dini segera setelah fungsi motorik pulih (skala Bromage 1) dan kelompok kedua mobilisasi setelah tirah baring selama 24 jam pascaseksio sesarea. Kemudian, setiap kelompok dilakukan pengamatan terhadap ada atau tidaknya PDPH sampai 2 hari pascaoperasi. Dari hasil penelitian dianalisis dengan uji statistik yaitu uji chi kuadrat dan uji Mann Whitney, di mana nilai p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa perbandingan insidensi PDPH pada kelompok yang dilakukan mobilisasi dini (setelah fungsi motorik pulih) dan tirah baring selama 24 jam tidak bermakna (p>0,05). Pada kelompok pertama (mobilisasi dini) 100% tanpa PDPH dan kelompok kedua (tirah baring 24 jam) 99% tanpa PDPH. Simpulan dari penelitian ini adalah tidak didapatkan perbedaan insidensi PDPH pada pasien pascaseksio sesarea dengan anestesi spinal yang dilakukan tirah baring selama 24 jam dengan mobilisasi dini segera setelah fungsi motorik pulih.

Kata kunci : mobilisasi dini, Post Dural Puncture Headache, seksio sesarea dengan anestesi spinal, tirah baring 24 jam


Comparison Of Post Dural Puncture Headache (PDPH) Incidence In Post Caesarean Section Using Spinal Anesthesia Underwent Bed Rest Position For 24 Hours Compared With Early Mobilization

Post Dural Puncture Headache (PDPH) is defined as an iatrogenic complication of spinal anesthesia. The pathophysiology of PDPH remains unknown until today, but the referenced theory is due to the decrease of the LCS (Liquor Cerebrospinal) volume and pressure. The early studies confirmed that PDPH was preventable with bed rest position for 24 hour. Numerous current studies have proven that early mobilization does not increase PDPH risks. The objective of this study was to prove that there is no significant difference in PDPH incidence in bed rest patients for 24 hours compared with early mobilization patients as soon as the motoric function has been recovered. The study was conducted using quasi experimental type and control time series design. This study involved 200 pregnant women at the age of 18-30 years that were on Caesarean Section using spinal anesthesia then they were classified into 2 groups with 100 subjects, respectively. The first group was conducted early mobilization as soon as the motoric function has been recovered (using Bromage 1 scale) and the second group was conducted mobilization after bed rest 24 hours post sectio Caesarean. And then, each group was observed for the occurrence of PDPH until 2 days post surgery. The study analysis was assessed using chi square test and Mann Whitney test, which the score of p<0,05 was considered statistically significant value. Statistical analysis showed that the comparison of PDPH incidence in the early mobilization group (after motoric function had been recovered) and the bed rest for 24 hour group was not statistically significant (p>0,05). The first group (early mobilization) showed 100% of the patients without PDPH incidence and the second group (bed rest for 24 hour) showed 99% of the patients without PDPH incidence. The summary of this study revealed that there was no significant difference on PDPH incidence in post Caesarean section patients underwent spinal anesthesia with bed rest for 24 hours compared with early mobilization as soon as the motoric function had been recovered.

Key words: Cesarean section with spinal anesthesia, early mobilization, Post Dural Puncture Headache, 24 hours bedrest


DOI: 10.15851/jap.v1n1.155





 

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