Perbandingan Angka Keberhasilan Blokade Saraf Iskiadikus Pendekatan Parasakral dengan Labat Menggunakan Stimulator Saraf pada Operasi Daerah Kruris dan Pedis

Abstract

Blokade saraf iskiadikus digunakan pada operasi daerah kruris dan pedis. Blokade saraf iskiadikus pendekatan Labat membutuhkan rangkaian penanda anatomis, sementara parasakral menggunakan penanda anatomis sederhana. Penelitian bertujuan membandingkan angka keberhasilan blokade saraf iskiadikus pendekatan parasakral dengan Labat. Penelitian uji acak terkendali tersamar ganda dilakukan pada 32 pasien dewasa di Rumah Sakit Dr. Hasan Sadikin Bandung dan Rumah Sakit Dr. Slamet Garut selama Desember 2014–Januari 2015. Tempat penyuntikan kelompok Labat pada 4 cm distal garis proyeksi tegak lurus terhadap pertengahan trokanter mayor dan spina iliaka superior posterior. Tempat penyuntikan kelompok parasakral pada 6 cm distal garis proyeksi antara spina iliaka superior posterior dan tuberositas iskiadikus. Penyuntikan 30 mL bupivakain 0,4% dilakukan bila terdapat respons motorik pada arus 0,3 mA. Perbandingan angka keberhasilan diuji dengan Uji Eksak Fisher, bermakna jika p<0,05. Blokade saraf iskiadikus kelompok parasakral berhasil pada 15 subjek, sedangkan Labat berhasil pada 8 subjek dengan nilai p=0,015. Angka keberhasilan blokade saraf iskiadikus pendekatan parasakral lebih tinggi dibanding dengan Labat menggunakan stimulator saraf pada operasi daerah kruris dan pedis.

Kata kunci: Blokade saraf iskiadikus, keberhasilan, penanda anatomis, pendekatan parasakral, pendekatan Labat

Comparison of Success Rates between Parasacral Approach and Labat Approach Applied in Sciatic Nerve Block Using Nerve Stimulator in Leg and Foot Surgeries


Anesthesiologist uses sciatic block in leg and foot surgeries. Labat sciatic block uses a series of anatomical landmarks, while parasacral uses simple anatomical landmarks. This study compared the success rate of parasacral approach of sciatic block to Labat approach using nerve stimulator in leg and foot surgeries. A double-blind randomized controlled trial study was conducted on 32 adult patients at Dr. Hasan Sadikin General Hospital Bandung and Dr. Slamet General Hospital Garut during the period of December 2014 to January 2015. In Labat group, a line was drawn from greater trochanter to posterior superior iliac spine. Then, from the midpoint of this line, a second line was drawn perpendicularly and extended caudally to 4 cm. The end of this line represented the needle entry. In parasacral group, a line was drawn from posterior superior iliac spine to ischial tuberosity. The needle entry was then marked on this line at 6 cm from the posterior superior iliac spine. Thirty mL of 0.4% bupivacaine was injected when a proper motor response was elicited at 0.3 mA. Comparison of success rates were analyzed using Fisher’s exact Test with p-value<0.05 considered significant. Fifteen blocks in parasacral group were successful compared to 8 blocks in Labat group, with p-value of 0.015. The success rate of parasacral approach of sciatic block is higher than in the Labat approach when using nerve stimulator in leg and foot surgeries.

Key words: Sciatic nerve block, success, anatomical landmarks, parasacral approach, Labat approach

DOI: 10.15851/jap.v3n3.613