Perbedaan Skala Nyeri antara Blok Pleksus Servikalis Superfisialis Levobupivakain dan Fentanil Intravena Pascaoperasi Mastoidektomi

Abstract

Penelitian tentang penggunaan blok pleksus servikalis superfisialis sebagai analgetik pascaoperasi mastoidektomi masih sangat terbatas baik di Indonesia maupun luar negeri. Tujuan penelitian mengetahui efektivitas blok pleksus servikalis superfisialis sebagai analgetik pascaoperasi mastoidektomi. Penelitian ini berdisain uji klinik acak tersamar tunggal pada 30 pasien yang dilakukan operasi mastoidektomi dan memenuhi kriteria inklusi di Rumah Sakit Dr. Moewardi Surakarta periode Oktober 2017–Februari 2018. Sampel dibagi menjadi 3 kelompok, yaitu kelompok fentanil intravena, blok pleksus cervicalis superfisialis dengan levobupivakain, dan blok pleksus cervicalis superfisialis dengan salin. Semua pasien mendapatkan perlakuan anestesi umum sesuai standar dan dinilai skala nyeri berkala pascaoperasi. Selain itu, juga dinilai efek mual-muntah pascaoperasi, kebutuhan opioid selama operasi, dan efek samping tindakan blok. Skala nyeri pascaoperasi mulai jam ke-2 sampai ke-24 pada kelompok fentanil intravena (nyeri ringan 80–90%) dan levobupivakain (nyeri ringan 90–100%) lebih rendah dibanding dengan kelompok salin (nyeri ringan 10–50%; nyeri sedang 50–70%) (p<0,05). Pada kelompok salin bahkan terjadi nyeri berat sebanyak 40% pada jam ke-2. Skor PONV pada kelompok fentanil, levobupivakain, dan salin mayoritas mual ringan (60%; 40%; dan 50%). Tidak ada komplikasi yan g terjadi terkait blok pleksus servikalis superfisialis. Simpulan, tidak ada perbedaan skala nyeri yang bermakna antara blok pleksus servikalis superfisialis levobupivakain dan fentanil intravena pascaoperasi mastoidektomi.

Kata kunci: Blok pleksus servikalis superfisialis, fentanil, levobupivakain, mastoidektomi

Difference in Pain Scale between Levobupivacaine Superficial Cervical Plexus Block and Intravenous Fentanyl for Post-Post-Mastoidectomy Pain

Research on the use of superficial cervical plexus block as an analgesic after mastoidectomy is still very limited both in Indonesia and abroad. The purpose of this study was to determine the efficacy of superficial cervical plexus block as an analgesics for post-post-mastoidectomy pain. This was a single blinded randomized clinical trial study performed on 30 patients underwent mastoidectomy who met the inclusion criteria in Dr. Moewardi General Hospital Surakarta October 2017–February 2018. Subjects were divided into 3 groups: levobupivacaine block, saline block, and intravenous fentanyl groups. All patients received standard general anesthesia treatment and  were evaluated periodically for the post-operative pain scale. The post-operative effects post-including  nausea-vomiting, opioid need during surgery, and side effects of  the block were also assessed. The pos-toperative pain scales 2 to 24 hours after surgery in the intravenous fentanyl (mild pain 80–90%) and levobupivacaine group (mild pain 90–100%) were lower than those in the saline group (mild pain 10–50%, moderate pain 50–70%) (p<0.05). In the saline group, severe pain was even identified 2 hours after the surgery in  as high as 40% of the subjects. Comparison of the pain scale between fentanyl and levobupivacaine groups from 2 to 24 hours after surgery did not show any significant difference. PONV scores in the fentanyl, levobupivacaine, and saline groups reflected mild nausea (60%, 40%, and 50% respectively). No complication occurred in superficial cervical plexus block application. In conclusion, there is no significant difference in pain scale between the superficial cervical plexus block using levobupivacaine and intravenous fentanyl in terms of  post-post-mastoidectomy pain.

Key words: Fentanyl, levobupivacaine, mastoidectomy, superficial cervical plexus block