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Perbandingan Efektivitas Anestesi Spinal dengan Bupivacain 12,5 Mg dan Bupivacain 5 Mg yang ditambah Fentanyl 50 Mcg pada Seksio Sesarea Fritzky Indradata; Heri Dwi Purnomo; Muh. Husni Thamrin; Sugeng Budi Santoso; Ardana Tri Arianto; RTH Supraptomo
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.55

Latar Belakang: Anestesi spinal mempunyai efek samping berupa hipotensi dan mual muntah. Tujuan: penelitian ini adalah membandingkan efek anestesi spinal bupivacain dosis normal 12,5 mg dan bupivacain dosis rendah 5 mg dengan fentanyl 50 mg pada seksio sesarea terhadap perubahan hemodinamik, ketinggian blok, onset, durasi dan efek samping. Subjek dan Metode: Penelitian double blind randomized control trial pada 36 pasien yang memenuhi kriteria. Pasien dibagi menjadi dua kelompok, yang masing-masing terdiri 18 pasien, kelompok 1 dilakukan anestesi spinal dengan bupivacain hiperbarik 5 mg ditambah adjuvan fentanyl 50 mcg, sedangkan kelompok 2 diberikan bupivacain hiperbarik 12,5 mg. Penilaian meliputi saat mula kerja blokade sensorik, mula kerja blokade motorik, durasi, tekanan darah, laju nadi, dan saturasi oksigen, lama kerja dan efek samping. Data hasil penelitian diuji secara statistik dengan uji chi-square. Hasil: Terdapat perbedaan signifikan pada onset dan durasi blokade sensorik dan motorik, bupivacain 12,5 mg lebih baik dibandingkan bupivacain 5 mg + fentanyl 50 mcg (p<0.05). Tidak ada perbedaan signifikan pada perubahan tanda vital dan efek samping (p>0.05). Simpulan: Bupivacain 12,5 mg menghasilkan onset lebih cepat dan durasi lebih lama dibandingkan bupivacain 5 mg + fentanil 50 mcg pada anestesi spinal untuk seksio sesarea Comparison of The Effectiveness Spinal Anesthesia with Bupivacaine 12,5 Mg and Bupivacaine 5 Mg added Fentanyl 50 Mcg in Caesarean Section Abstract Background: Spinal anesthesia has side effects such as hypotension and nausea and vomiting. Objective: The aim of this study was to compare the effects of spinal anesthesia with normal doses of 12,5 mg of bupivacaine and 5 mg of low-dose bupivacaine with fentanyl 50 mg in the cesarean section on hemodynamic changes, block height, onset, duration, and side effects. Subjects and Methods: Double-blind randomized control trial in 36 patients who met the criteria. Patients were divided into two groups, each consisting of 18 patients, group 1 underwent spinal anesthesia with 5 mg of hyperbaric bupivacaine plus 50 mcg of fentanyl adjuvant, while group 2 was given 12,5 mg of hyperbaric bupivacaine. Assessments include the initiation of sensory block action, onset of motor block action, duration, blood pressure, pulse rate, and oxygen saturation, duration of action, and side effects. The research data were statistically tested with the chi-square test. Results: There were significant differences in the onset and duration of sensory and motor blockade, bupivacaine 12,5 mg was better than bupivacaine 5 mg + fentanyl 50 mcg (p <0.05). There was no significant difference in changes in vital signs and side effects (p> 0.05). Conclusion: Bupivacaine 12,5 mg resulted in a faster onset and longer duration than bupivacaine 5 mg + fentanyl 50 mcg in spinal anesthesia for cesarean section.

Dexmedetomidine as a Neuroprotective Sedative Agent in Ultrasound-Guided Ulnar Nerve Block for a Patient with Traumatic Brain Injury: A Case Report Aryanda Widya Tazkagani Salsabila; Heri Dwi Purnomo
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.688

Introduction: Traumatic brain injury (TBI) often presents alongside extracranial injuries requiring surgical intervention. General anesthesia in such cases poses significant challenges, particularly in patients with concomitant pulmonary complications. This case report describes the successful use of ultrasound-guided ulnar nerve block combined with dexmedetomidine sedation for a patient with moderate TBI and pulmonary contusion undergoing open reduction and internal fixation (ORIF) of a left-hand finger fracture. Case presentation: A 50-year-old male presented with moderate TBI, pulmonary contusion, and an open fracture of the fifth digit of his left hand following a motor vehicle accident. Due to the risks associated with general anesthesia, an ultrasound-guided ulnar nerve block was performed using levobupivacaine 0.375%. Dexmedetomidine was used as a sedative agent due to its neuroprotective properties and minimal respiratory depressant effects. The procedure was successful, with the patient maintaining stable hemodynamics and adequate sedation throughout the surgery. Conclusion: This case highlights the feasibility and safety of ultrasound-guided peripheral nerve block combined with dexmedetomidine sedation as an alternative to general anesthesia in patients with TBI and pulmonary contusion. Dexmedetomidine's neuroprotective effects and minimal respiratory depression make it a valuable tool in managing such complex cases.

Anesthetic and Analgesic Management for Mastectomy of a Giant Phyllodes Tumor: A Case Report on the Central Role of the Serratus Anterior Plane Block Heri Dwi Purnomo; Bara Aditya; Yasyfie Asykari; Rafael Bagus Yudhistira
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.784

Mastectomy for giant breast tumors presents a formidable clinical challenge due to the anticipated extensive surgical trauma, significant inflammatory response, and high risk of severe postoperative pain. This intense nociceptive barrage can lead to central sensitization and the development of debilitating Post-Mastectomy Pain Syndrome (PMPS). A robust, opioid-sparing multimodal analgesic strategy is therefore not just beneficial, but essential. The Serratus Anterior Plane Block (SAPB) is a regional anesthetic technique integral to such a strategy. We present the case of a 39-year-old, 60 kg female with a giant (24 x 22 x 18 cm) right-sided phyllodes tumor scheduled for mastectomy. The anesthetic plan consisted of general anesthesia and a preemptive, ultrasound-guided deep SAPB using 20 mL of 0.25% levobupivacaine. The procedure was performed with meticulous attention to sonoanatomy and technique. Intraoperatively, the patient maintained profound hemodynamic stability with minimal requirement for volatile anesthetic. Postoperatively, the patient reported complete analgesia, with Visual Analog Scale (VAS) scores of 0 at rest and 0-1 with movement (dynamic pain) for the first 24 hours. Sensory testing confirmed a dense block from T2 to T7. The patient required no rescue analgesia, mobilized early, and reported high satisfaction with her recovery. The final pathology confirmed a borderline phyllodes tumor. In conclusion, this case report demonstrates that a meticulously performed, ultrasound-guided deep SAPB can serve as the cornerstone of an effective, opioid-sparing analgesic regimen for high-pain-risk breast surgery. It can provide complete and functional postoperative analgesia, enhance hemodynamic stability, and facilitate recovery, embodying the core principles of Enhanced Recovery After Surgery (ERAS) pathways.

Optimizing the Surgical Field via Multimodal Controlled Hypotension during Posterior Spinal Fixation for a T11 Burst Fracture: An Anesthetic Case Study Juliana; Heri Dwi Purnomo
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1455

Background: Significant intraoperative blood loss is a major challenge in complex spinal surgeries, impairing surgical field visibility and increasing patient morbidity. Controlled hypotension is an established anesthetic technique to mitigate this challenge, yet the optimal combination of agents to ensure efficacy and safety remains an area of active investigation. This case study details the successful application of a multimodal anesthetic regimen, centered on the synergistic effects of dexmedetomidine and isoflurane, to achieve deliberate hypotension during posterior stabilization of a thoracic burst fracture. Case presentation: A 39-year-old male, classified as American Society of Anesthesiologists (ASA) physical status II, presented with a traumatic, unstable burst fracture of the eleventh thoracic vertebra (T11) following a high-energy fall. He was scheduled for a posterior decompressive laminectomy and T10-T12 pedicle screw fixation. Anesthetic management was initiated with a multimodal approach utilizing intravenous infusions of dexmedetomidine and morphine, supplemented by maintenance with isoflurane. This strategy was employed to maintain a target mean arterial pressure (MAP) of 60-65 mmHg. Throughout the 135-minute procedure, the patient’s hemodynamics remained exceptionally stable within the target range. The estimated blood loss was minimal (approximately 350 mL), providing the surgical team with an excellent, clear operative field. The patient emerged smoothly from anesthesia with no neurological deficits and experienced a favorable postoperative recovery. Conclusion: This case demonstrates that a multimodal anesthetic strategy incorporating dexmedetomidine, a volatile agent, and opioid infusions is a highly effective and safe method for inducing and maintaining controlled hypotension in major spinal surgery. This approach successfully optimized the surgical conditions by minimizing blood loss and enhancing visibility, without compromising hemodynamic stability or vital organ perfusion, thereby contributing to a positive patient outcome.

Optimizing the Surgical Field via Multimodal Controlled Hypotension during Posterior Spinal Fixation for a T11 Burst Fracture: An Anesthetic Case Study Juliana; Heri Dwi Purnomo
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1455

Background: Significant intraoperative blood loss is a major challenge in complex spinal surgeries, impairing surgical field visibility and increasing patient morbidity. Controlled hypotension is an established anesthetic technique to mitigate this challenge, yet the optimal combination of agents to ensure efficacy and safety remains an area of active investigation. This case study details the successful application of a multimodal anesthetic regimen, centered on the synergistic effects of dexmedetomidine and isoflurane, to achieve deliberate hypotension during posterior stabilization of a thoracic burst fracture. Case presentation: A 39-year-old male, classified as American Society of Anesthesiologists (ASA) physical status II, presented with a traumatic, unstable burst fracture of the eleventh thoracic vertebra (T11) following a high-energy fall. He was scheduled for a posterior decompressive laminectomy and T10-T12 pedicle screw fixation. Anesthetic management was initiated with a multimodal approach utilizing intravenous infusions of dexmedetomidine and morphine, supplemented by maintenance with isoflurane. This strategy was employed to maintain a target mean arterial pressure (MAP) of 60-65 mmHg. Throughout the 135-minute procedure, the patient’s hemodynamics remained exceptionally stable within the target range. The estimated blood loss was minimal (approximately 350 mL), providing the surgical team with an excellent, clear operative field. The patient emerged smoothly from anesthesia with no neurological deficits and experienced a favorable postoperative recovery. Conclusion: This case demonstrates that a multimodal anesthetic strategy incorporating dexmedetomidine, a volatile agent, and opioid infusions is a highly effective and safe method for inducing and maintaining controlled hypotension in major spinal surgery. This approach successfully optimized the surgical conditions by minimizing blood loss and enhancing visibility, without compromising hemodynamic stability or vital organ perfusion, thereby contributing to a positive patient outcome.

Hemodynamic-Focused Anesthetic Strategy for Duodenal Atresia with Annular Pancreas in a Low-Birth-Weight Neonate: A Case Report and Pathophysiological Review Wardhana, Anggia Rarasati; Ardana Tri Arianto; Heri Dwi Purnomo
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.802

Introduction: The anesthetic management of low-birth-weight (LBW) neonates with complex congenital anomalies like duodenal atresia presents a profound physiological challenge. These patients exhibit immature organ systems, precarious fluid balance, and heightened sensitivity to anesthetic agents. This case report describes a successful hemodynamically-focused anesthetic strategy in a particularly high-risk neonate with the combined pathology of duodenal atresia and a constricting annular pancreas. Case presentation: A 4-day-old, 1800-gram male infant, born at 37 weeks with intrauterine growth restriction, presented with prenatally diagnosed duodenal atresia. Preoperative stabilization focused on correcting a severe hypochloremic, hypokalemic metabolic alkalosis. A hemodynamically stable anesthetic induction was achieved using intravenous fentanyl (2.8 mcg/kg) and ketamine (2.8 mg/kg), avoiding myocardial depressant volatile agents. Anesthesia was maintained with 60% oxygen in air and intermittent opioid boluses. Intraoperative management was centered on meticulous, goal-directed fluid therapy, rigorous maintenance of normothermia, and lung-protective ventilation. The surgery, a duodenojejunostomy, was completed successfully with remarkable hemodynamic stability. The infant was transferred to the NICU for planned postoperative ventilation and was extubated on the second postoperative day. Postoperative analgesia was achieved with a continuous sub-anesthetic ketamine infusion, later transitioned to intermittent metamizole. Conclusion: The successful outcome in this fragile neonate underscores the value of a tailored anesthetic approach grounded in neonatal pathophysiology. A strategy utilizing hemodynamically stable induction agents, proactive correction of metabolic derangements, goal-directed fluid therapy, and a planned, staged recovery can effectively mitigate the significant perioperative risks associated with major abdominal surgery in LBW infants with complex congenital anomalies.

Opioid-Sparing Anesthesia: The Dual Efficacy of Ketamine on Postoperative Pain and Systemic Inflammation Following Spinal Surgery Elanda Rahmat Arifyanto; Ardana Tri Arianto; Heri Dwi Purnomo
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.804

Introduction: Postoperative pain and inflammation after major spinal surgery, such as laminectomy, pose significant challenges to patient recovery and contribute to opioid consumption. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is proposed to have both analgesic and anti-inflammatory properties, positioning it as a key component of an opioid-sparing strategy. This study aimed to evaluate the clinical efficacy of a specific intraoperative ketamine infusion regimen compared to a continuous micro-dose morphine regimen on early postoperative pain and systemic inflammation. Methods: This prospective, double-blind, randomized controlled trial included 24 adult patients (ASA I-II) undergoing thoracolumbar laminectomy. Patients were randomly assigned to receive either a continuous intraoperative infusion of ketamine at 10 mcg/kg/minute (n=12) or morphine at 10 mcg/kg/hour (n=12). The primary outcomes were postoperative pain intensity, measured by the Visual Analog Scale (VAS) at 6 and 12 hours, and the systemic inflammatory response, assessed via high-sensitivity C-reactive protein (hs-CRP) levels measured preoperatively and 6 hours postoperatively. Results: The study groups were comparable regarding baseline demographic and surgical characteristics (p>0.05). At 6 hours postoperatively, the ketamine group reported significantly lower VAS pain scores than the morphine group (mean score of 2.33 ± 0.78 versus 3.83 ± 1.03, respectively; p=0.001). This difference was not maintained at 12 hours (p=0.646). Critically, the surgically-induced increase in hs-CRP was significantly attenuated in the ketamine group, which showed a mean increase of only 1.43 ± 1.04 mg/L from baseline, compared to a much larger increase of 2.88 ± 1.06 mg/L in the morphine group (p=0.003). Conclusion: An intraoperative ketamine regimen of 10 mcg/kg/minute is more effective at reducing pain in the immediate 6-hour postoperative period and mitigating the systemic inflammatory response than a continuous micro-dose morphine regimen. These findings underscore ketamine's potent dual-mechanism action, targeting both nociceptive and inflammatory pathways, and strongly support its use in multimodal, opioid-sparing protocols for spinal surgery.

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