Lama Pengerjaan, Volume Anestetik Lokal, dan Angka Keberhasilan Blokade Aksilar dengan Panduan Pencitraan Ultrasonografi pada Prosedur Arterio-Venous Shunt

Abstract

Kunci keberhasilan melakukan blokade aksilar adalah mendistribusikan secara optimal anestetik lokal ke sekeliling saraf, hal ini tercapai dengan panduan pencitraan ultrasonografi. Penelitian ini bertujuan menilai lama pengerjaan, volume  anestetik lokal, dan angka keberhasilan blokade aksilar dengan panduan pencitraan ultrasonografi. Metode penelitian adalah deskriptif prospektif. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Maret–April tahun 2014 terhadap 40 pasien (21‒60 tahun), status fisik American Society of Anesthesilogist (ASA) II, menjalani pembedahan dalam blokade aksilar dengan panduan pencitraan ultrasonografi. Fungsi sensorik dan motorik dinilai setiap 5 menit selama 15 menit. Keberhasilan blokade dinilai dari hilangnya fungsi sensorik dan motorik pada saraf medialis, radialis, ulnaris, dan muskulokutaneus. Hasil penelitian didapatkan lama pengerjaan blokade aksilar rata-rata dengan panduan pencitraan ultrasonografi 548 detik (9,1 menit), volume anestetik lokal dibutuhkan 10 mL dan angka keberhasilan blokade aksilar sebesar 97,5%. Penelitian lain lama pengerjaan dengan bantuan alat stimulasi saraf tepi selama 11,2 menit, volume total anestetik lokal dibutuhkan 30‒40 mL, dan angka keberhasilan 60‒85%.  Simpulan, panduan pencitraan ultrasonografi dapat mempersingkat pengerjaan, mengurangi volume obat anestesi lokal, dan meningkatkan keberhasilan blokade aksilar.

Kata kunci: Arterio-venous shunt, blokade aksilar, panduan ultrasonografi

Procedure Time, Local Anaesthetic Volume, and Success Rate of Axillary Block with Ultrasound Guidance in Arterio-Venous Shunt Procedure


The key requirement for successful axillary block is to ensure optimal distribution of local anesthetic around the nerve structure. This goal is most effectively achieved under sonographic visualization. This study aimed to assess block procedure time, minimum volume of local anesthetic required, and success rate of axillary brachial plexus block under ultrasound guidance. This study was conducted between March and April 2014 in Dr. Hasan Sadikin General Hospital, Bandung. This was an observational prospective study involving 40 patients (21‒60 years old) with American Society of Anesthesiologist (ASA) physical status II who underwent arterio-venous shunt under axillary brachial plexus block. Sensory and motor functions were assessed every five minutes for 15 minutes. A successful block was defined as complete sensoric and motoric loss in median, radial, ulnar, and musculocutaneus nerve distributions by 15 minutes. Results showed average block procedure time of 548 seconds (9.1 min), total volume of local anesthetic of 10 mL, and  block success rate of 97.5%. This study concludes that ultrasound guidance can reduce block procedure time and required local anesthetic volume as well as improving the success rate of axillary brachial plexus block.

Key words: Arterio-venous shunt, axillary block, ultrasound guidance

DOI: 10.15851/jap.v2n3.329