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All Journal Jurnal Anestesiologi Indonesia Solo Journal of Anesthesi, Pain and Critical Care
Utama, Sigit Prasetya
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Chemical Engineering, Chemistry & Bioengineering Health Professions Medicine & Pharmacology Nursing Public Health

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Adductor Canal Block (ACB) as an Adequate Analgesia Post Anterior Cruciate Ligament Repair Utama, Sigit Prasetya; Kuntoadi, Danang; Yuliana, Friskha
JAI (Jurnal Anestesiologi Indonesia) Vol 16, No 3 (2024): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.61865

Abstract

Background: Anterior cruriate ligament (ACL) injury is one of the most common cases in knee injury. Inadequate pain management will cause a decrease in quality of life, daily living abilities, increase hospitalization costs, and progressively causing chronic pain. Selection of inappropriate peripheral nerve block (PNB) can reduce range of movement ROM. Abductor canal block (ACB) is expected to facilitate adequate analgetic, improve early mobilization and ambulation, reduce the risk of post operative nausea vomiting (PONV), and needs for other analgeticsCase: A 21-year-old male patient with a diagnosis of ACL rupture knee (S) who will be performed anterior cruriate ligament recontruction (ACLR) procedure with physical status ASA II, premedication ondancentron 4 mg and dexamethasone 5 mg intravenously. Regional anesthesia subarachnoid block, at L3-L4 interspatium with bupivacaine hyperbaric 0.5% 15 mg and fentanyl 25 mcg as the adjuvant for subarachnoid block. Adductor canal block using ultrasound guide using 20 ml levo bupivacaine 0.25%. The outcome assessed using nurmmeric rating score (NRS), PONV, rescue analgetics, and ambulation score which includes: time up to go (TUG) with partial weight bearing, s-CST, 5xSST, 6 WMT straight leg raising (SLR) assessed at more than 48 hours.Discussion: PNB is proven to be reliable and effective for postoperative pain control, ambulation, rehabilitation and mobilization are also faster, adequate pain control will facilitate early mobilization and prevent side effects related to prolonged immobilization. Adductor canal block is a good modality as an adequate analgetic, the use of ACB can reduce use of rescue analgetic, reduce the incidence of PONV and support early mobilization.Conclusion: ACB in ACLR can facilitate adequate analgesia, does not require other rescue analgetics, reduce the incidence of PONV, and improve the ambulation as well as avoid other complications.
Fascia Iliaca Compartment Block as Pain Management for Postoperative Femur Fracture in the Elderly: A Case Report Utama, Sigit Prasetya; Yuliana, Friskha; Kuntoadi, Danang
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 3 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.66116

Abstract

Background: Femur fractures are most common in geriatric patients, necessitating careful consideration of perioperative medications. Effective pain management is crucial to minimize neurohormonal stress responses. Reducing opioid use in older patients can prevent side effects and complications. The fascia iliaca compartment block (FICB) is a safe and efficient nerve block method, known to decrease opioid needs in hip surgery. It is anticipated to enhance mobilization speed and ambulation and reduce postoperative nausea, vomiting, deep vein thrombosis (DVT), and pneumonia, thereby improving overall outcomes for geriatric patients undergoing hip surgery.Case: A 71-year-old female with a closed right intertrochanteric femur fracture underwent open reduction and internal fixation with a proximal femoral nail antirotation. Classified as ASA II, geriatric, with stage I hypertension, her preoperative vital signs included a blood pressure of 170/95 mmHg, heart rate of 65 beats per minute, respiration rate of 20 times per minute, and SpO2 of 98% with nasal cannula oxygen at 3 lpm. Spinal anesthesia was administered at L3-L4, and an FICB was performed postoperatively. Pain assessment, rescue analgesic use, and postoperative nausea were evaluated post-surgery, with monitoring at 6, 24, and 48 hours.Discussion: Pain management with regional FICB anesthesia can simultaneously block the femoral nerve, obturator nerve, and lateral femoral cutaneous nerve. Thus, minimizing systemic symptoms compared to analgesics administered intravenously. In this case, the administration of 30 cc of levobupivacaine via a FICB provided effective analgesia for up to 72 hours post-blockade in a geriatric patient without causing side effects, such as postoperative nausea.Conclusion: Postoperative FICB for hip surgery in geriatric patients provides effective analgesia with minimal side effects. 
Peripheral Nerve Block as A Safer Alternative than General Anesthesia in High-Risk Patients with Multiple Comorbidities: A Case Report Kuntoadi, Danang; Utama, Sigit Prasetya; Yuliana, Friskha; Hermawan, Andi
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 1 (2025): April 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i1.95022

Abstract

Background : Managing anesthesia in high-risk patients with multiple comorbidities is a significant challenge, particularly when general anesthesia may increase perioperative risks. Peripheral nerve block offers a safer alternative by minimizing systemic involvement and avoiding complications associated with general anesthesia.Case Illustration : This case report presents a 68-year-old male with uncontrolled hypertension and a history of stroke who underwent surgery for a clavicle fracture. Due to the patient's cardiovascular and neurological risks, regional block anesthesia was chosen as the preferred technique. The approach allowed for stable perioperative management without complications.Conclusion : This case emphasizes the potential benefits of peripheral nerve block in high-risk surgical patients, offering a safer and effective alternative to general anesthesia.
Therapeutic Plasma Exchange in High Care Unit for Patient with a Snake bite : a Case Report Setijanto, Eko; Pambayun, Isma Angger; Utama, Sigit Prasetya; P, Septian Adi
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 1 (2025): April 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i1.77939

Abstract

Background : Snake bites are one of the commonest occupational hazards in tropical countries and viperine bites are potential to cause systemic toxicity. Hemolitik anemia, coagulopathies, and acute kidney injury (AKI) have been documented, main therapy on snake bite with antivenom, when it combine with plasmapheresis it shown promising result. This case reports highlight the effective use of plasmapheresis for snake bite therapy.Case Illustration : A 40-year old presented following 7-days at HCU Dr Moewardi Hospital of snake bite with the right hand is swollen, blistered, painful, weakness, nausea, the yellowish body, icteric conjunctiva, and dark brown colored urin. A patient has anemia, leukocytosis, thrombocytopenia, increased total bilirubin, direct bilirubin, indirect bilirubin, elevate liver enzyme, and uremia. The patient was treated for 7 days in the HCU. Patient received 10 cc of antivenom in 500 cc 0,9% normal saline every 8 hours for 3 days. Patient also received one times therapeutic plasma exchange (TPE) on 2nd of admission, TPE with 2.500 ml output of plasma. The patient had received 8 flash 5% albumin therapy, with each flash contains 250 cc of 5% albumin and 1 flash 0,9% normal saline, with each flash contains 500 cc of 0,9% normal saline, with total liquid intake is 2500 cc. Patient with GCS E4V5M6.Conclusion : Most patients with snake bite present with hemolitik anemia, coagulopathies, and acute kidney injury (AKI). The management of snake bite is mainly with antivenom. In addition plasmapheresis not only eliminate the venom circulating in the blood, would also eliminate the toxins diffused into extravascular spaces and target organs after redistribution phenomenon. Therefore, therapeutic plasma exchange should be utilized as part of a tailored treatment plan that considers the patient's overall clinical condition and needs. This case report a 40-year-old as show evidence for the effectiveness of plasmapheresis treatment.
Co-Authors andi hermawan Eko Setijanto Kuntoadi, Danang P, Septian Adi Pambayun, Isma Angger Yuliana, Friskha