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Solo Journal of Anesthesi, Pain and Critical Care
Published by Universitas Sebelas Maret
ISSN : 27761770     EISSN : 27970035     DOI : https://doi.org/10.20961
Core Subject : Health, Engineering,
Chemical Engineering, Chemistry & Bioengineering Health Professions Medicine & Pharmacology Nursing Public Health
Case Report, Original Research and Review Article in the scope of : Life Support Emergency and Trauma Cardiovascular Anesthesia Pediatric Anesthesia Neuro Anesthesia Pain Management Intensive Care Obstetry Anesthesia Geriatric and Oncology Anesthesia Regional Anesthesia Ambulatory Anesthesia
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 75 Documents
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Erector Spinae Block vs Paravertebral Block in Breast Cancer Surgery: A Systematic Review and Meta-analysis Tri Cahyo, Rizky Rahmad; Sutiyono, Doso; Karmila, Intan; Aufakamilia, Ismini
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 2 (2025): October 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i2.67351

Abstract

 Background :The paravertebral block (PVB) is the gold standard for postoperative analgesia in breast surgery, but it easily causes pneumothorax. Erector spinae plane block (ESPB) is considered as alternative to PVB because its less invasive so relative safer. However, evidence in favor of these techniques is lacking. Method :A search of PubMed Central, Cochrane Library, Wiley Online Library, and ClinicalTrials.gov to identify the latest 20 years studies comparing ESPB and PVB in breast cancer surgery was conducted. Our endpoints were: intraoperative fentanyl consumption, total postoperative morphine, and time to first analgesic request. Result :A total of 6 studies (394 patients) were included for this meta-analysis. The pooled analysis showed there is -3.03 (MD = -3.03: 95% CI: -7.47– 1.42) mean difference with insignificant overall effect (P = 0.18) for intraoperative fentanyl consumption on ESPB patient after breast cancer surgery compared against PVB procedure. There is an insignificant between ESPB and PVB regarding total postoperative morphine with 0.46 (MD = 0.46: 95% CI: -0.94 – 1.85) mean difference with insignificant overall effect (P =0.52). There is a significant difference between ESPB and PVB regarding time to first analgesic request with 0.23(MD = 0.23: 95% CI: 0.01– 0.44) risk ratio with statistically significant overall effect (P = 0.04). Both intraoperative fentanyl consumption and total postoperative morphine consumption showed heterogeneity. Meanwhile, time to the first analgesic request showed no heterogeneity. Conclusion : PVB is superior to ESPB regarding time to first analgesic request, but ESPB can serve as analternative to PVB with a similar analgesic effect   
Regenerative Pain Therapy Using Platelet-Rich Plasma Compared with Steroid Injection for Spinal Disc Herniation: A Meta-Analysis Rohman, Alfan Rizki Nur; Siswagama, Taufiq Agus; Putra, Probo Yudha Pratama
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 2 (2025): October 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i2.103270

Abstract

Background: Radicular pain resulting from spinal conditions remains one of the most challenging problems for clinicians. This meta-analysis aimed to compare the interventional pain outcomes of platelet-rich plasma (PRP) injection versus steroid injection in patients with disc herniation.Methods: A systematic review was conducted following PRISMA guidelines using PubMed, Science Direct, Cochrane Library, and RevMan 5.3. Three RCTs were analyzed.Results: A total of 204 patients were included (PRP n = 101; control n = 103). There was no significant difference between the PRP and steroid for VAS (Visual Analog Scale), ODI (Oswestry Disability Index), and SF-36 scores at 3 and 6 months.Conclusion: PRP provides similar pain reduction compared with steroid injection, with the additional advantage of potential regenerative effects. Further studies are warranted to evaluate structural regeneration
Dexmedetomidine vs. Other Sedatives in Mechanically Ventilated Sepsis Patients: Updated Meta-analysis Putera, Rizky Eka; Yudhistira, Rafael Bagus; Onggowasito, Livilia Abigail; Sudiono, Nathania Ella
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 2 (2025): October 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i2.106536

Abstract

Introduction. Globally, the incidence of sepsis is estimated at over 400 cases per 100,000 population annually, making it a major public health concern.  .   In this setting, sedation is essential to ensure patient-ventilator synchrony and reduce physiological stress. Dexmedetomidine is a selective α₂-agonist often used instead of traditional sedatives because it provides light sedation, lowers the risk of delirium, and may reduce inflammation. However, clinical outcomes remain inconsistent across studies. To assess the clinical effects of dexmedetomidine compared to other sedatives in mechanically ventilated sepsis patients.Methods. A comprehensive literature search of Pubmed, Scopus, Cochrane Central, Scilit, and Epistemonikos was performed to identify studies published from 2020 to 2025. Inclusion criteria included Randomized Controlled Trial (RCT) studies that directly compared dexamethomidine as sedation and involving sepsis patients with mechanical ventilation. Risk of Bias was estimated using RoB2.0 and meta analysis was using Revman 5.4.Results. Eight randomized control trials (n = 1119) were included. Compared to other sedatives, dexmedetomidine prolonged hospital LOS significantly (MD = 1.47; 95% CI: 0.59 to 2.34; p = 0.001), reduced ICU LOS significantly (MD = -0.91; 95%CI = -1.51 to -0.29; p = 0.004), not improving the event of mortality insignificantly (OR = 0.99; 95% CI: 0.71–1.37; p = 0.95), reduced ventilator-free days insignificantly (MD = –0.85; 95% CI = –1.94 to 0.25; p = 0.13), and improved lactate clearance insignificantly (MD = 0.54; 95%CI = -0.41 to 1.49; p = 0.21)Conclusion. Dexmedetomidine reduces ICU length of stay and may offer early mortality benefits at 28 days in mechanically ventilated sepsis patients. However, its effects on hospital stay, lactate clearance, and ventilator-free days remain uncertain, and further standardized trials are needed.
Optimizing Critical Care for the Obese Population: From Physiology to Practice Argoseto, Argoseto; Adiyanto, Bowo; Prasamya, Erlangga
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 6, No 1 (2026): April 2026
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v6i1.108499

Abstract

Obesity poses distinct issues in the Intensive Care Unit (ICU) owing to its related physiological changes, comorbidities, and the intricacies of management.  Obese individuals face heightened risks for respiratory problems, cardiovascular issues, and metabolic dysregulation.Effective management necessitates customized strategies:  Respiratory Support: Elevated positive end-expiratory pressure (PEEP), prone positioning, as well as tailored ventilatory modifications are crucial for managing impaired breathing mechanics and averting lung injury. Hemodynamic Management: Careful fluid management and non-invasive monitoring are needed to address altered cardiovascular dynamics and optimize perfusion. Pharmacologic Adjustments: Dosage modifications for sedatives, analgesics, and vasoactive agents accommodate altered drug metabolism and distribution. Nutritional Support: Hypocaloric, high-protein feeding is advised to meet energy needs while avoiding overfeeding, ideally guided by indirect calorimetry. Thromboprophylaxis and Mobility: Heightened risk for venous thromboembolism (VTE) requires higher anticoagulant doses and early mobilization using bariatric equipment. Furthermore, obesity can also caused obesity paradox, an unexpected survival benefit in septic patients with obesity, likely due to enhanced energy reserves, RAAS activation, and anti-inflammatory effects.A multidisciplinary and individualized approach is critical to improving outcomes in obese ICU patients, highlighting the need for updated clinical guidelines and further research tailored to this population.
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.
The Relationship between Total Carbondioxide and Lactate Levels to Hypovolemic Shock Post-CABG in ICU Dr Kariadi General Hospital Hayanto, Aria Pratama; Widyantoro, Adhitya Putra; Jatmiko, Heru Dwi; Sasongko, Himawan
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 6, No 1 (2026): April 2026
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v6i1.77912

Abstract

Background: A total of 2.4% of patients after Coronary artery bypass grafting (CABG) required reoperation due to postoperative bleeding leading to vasodilatory shock syndrome. The condition of metabolic acidosis was common in shock patients where a low serum TCO2 value could be used as an indicator. Lactic acidosis was the most common cause of metabolic acidosis in hospitalized patients. TCO2 measurement was more useful to determine anion gap, but still rarely utilized. The correlation of TCO2 and lactate levels were not known well in hypovolemic shock. This research aims to analyzing the correlation of serum TCO2 values and lactate levels to the condition of hypovolemic shock post CABG.Method: This study was an observational prospective cohort study. 23 subjects were post-CABG patients undergoing treatment at Dr. Kariadi as of January-February 2023. Data were obtained from hemodynamics status, measuring serum TCO2 and lactate levels in blood samples from patients taken 1 hour after surgery. The data were then processed using fischer’s exact test.Results: 26.1% subjects were experiencing hypovolemic shock post-CABG. Correlation analysis between lactate, TCO2 artery, and TCO2 vein to the condition hypovolemic shock post-CABG showed strong correlation (p=0.009; p=0.003; p=0.003). The correlation of lactate levels and TCO2 values both artery and vein resulted strong correlation (p=0.026). Cut-off lactate level delta was 5.8; cut-off TCO2 Artery delta was 20.5; cut-off TCO2 vein delta was 21.55 which were all measured using the ROC curve.Conclusion: TCO2 serum and lactate levels have strong correlation to the condition hypovolemic shock post-CABG patients. 
Pain Management with Ganglion Impar Block in Adenocarcinoma Recti Yogo, Wi; Laksono, Ristiawan Muji; Asmoro, Aswoco Andyk; Isngadi, Isngadi; Laksono, Buyung Hartiyo; Jaya, Wiwi
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 1 (2024): April 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i1.68927

Abstract

Background:Colorectal cancer is a type of malignant neoplasm that is often found with the third highest mortality rate in the world after breast cancer and lung cancer. Adenocarcinoma is the most common type of colorectal cancer which cause pain to the patient. The pain from this disease was described as chronic pain. Chronic pain can result from ongoing nerve inflammation and central sensitization. Inflammation begins with a mechanical injury which then turns into chronic inflammation. This situation changes the responsiveness of neurons to pain in the sympathetic ganglion. Sympathetic ganglia block is more effective in controlling visceral pain. This impar ganglion is the only sympathetic nervous system ganglion that is not attached to the sacrococcygeal. In this case report, the transsacrococcygeal joint approach was used to locate the ganglion accurately by injecting contrast and viewing the vertical dispersion called inverted commas along the ganglion laterally.Case Illustration: A 60-year-old female patient was admitted with complaints of pain around the anus. The patient has been diagnosed with Adenocarcinoma recti two years ago.  Pain is felt like being stabbed and persists in the anal area. Pain intensity increases on sitting and defecation. The patient has undergone chemotherapy 12 times and is taking pain relievers that have been prescribed regularly. The patient's Numeric Rating Scale (NRS) score is 6-7, which is categorized as severe pain. This patient underwent ganglion impar block using the trans sacrococcygeal joint approach with the help of fluoroscopy to relieve the severe pain.Conclusion: Ganglion Impar Block (GIB) can be performed with significant results in reducing opioid use and reducing pain in patients with Adenocarcinoma recti. The technique of administering neurolysis agents with the help of fluoroscopy can be an option because it is very effective and simple
Regional Anesthesia vs Opioid Therapy for Postoperative Pain Management in Cardiac Surgery: A Systematic Review Atalia, Arila; Cresma, Avisa Cetta; Athallah, Ariq Fadhil; Putri, Ritma Ratri Ayunda; Dewa, Putra Mahakarya
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.v5i1.91746

Abstract

Background : Postoperative pain after cardiac surgery can persist for extended periods, with up to 43% of patients experiencing pain three months post-surgery, and is associated with inadequate management and intense acute postoperative pain. Peripheral sensitization due to tissue injury and central sensitization within the central nervous system contributes to heightened pain sensitivity post-surgery. While opioids are effective, concerns over their adverse effects and potential for misuse prompt a shift towards multimodal analgesia, including regional anesthesia. Despite its advantages, there has been no comprehensive review comparing regional anesthesia and opioids in cardiac surgery. This study aims to systematically review randomized controlled trials to compare the effectiveness of these pain management strategies. context and purpose of the study.Methods: The literature search was performed across four databases. This study focuses on the postoperative pain scale. Regional block intervention relieves pain in cardiac surgery patients by administering local anesthetics near nerves, which minimizes reliance on systemic opioids and their associated side effects. This approach enhances patient comfort, accelerates recovery, and reduces the risk of opioid dependence. Quality was assessed using the Cochrane Risk of Bias Tool 2. A total of ten articles were included in this systematic review.Result : The analysis of pain scale data from eight studies revealed significant reductions in postoperative pain with regional block interventions compared to controls. Opioid consumption was notably reduced, indicating a decreased reliance on opioids. The length of time to extubation varied, with the intervention group showing a shorter duration compared to the controls. Adverse effects, including diaphoresis and nausea, were reported, but further research is needed to investigate these effects thoroughly.Conclusion: Regional anesthesia has proven effective in reducing postoperative pain and minimizing both the dose and duration of opioid use.
Evaluating the Role of Magnesium Sulphate as an Adjunct Therapy in Non-Obstetric Refractory Status Epilepticus Panjaitan, Sondang; Prasamya, Erlangga
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 2 (2025): October 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i2.102964

Abstract

Background : Refractory Status Epilepticus (RSE) is a condition of persistent status epilepticus seizures despite appropriate anticonvulsant therapy. RSE can be fatal if not treated promptly and properly. Standard treatments for SE and RSE include benzodiazepines as first line, non-benzodiazepine agents as second line, and general anesthetic agents as third line. Magnesium Sulfate (MgSO4) is known as an anticonvulsant agent that is more often used in obstetric cases, but its use in non- obstetric RSE is limited. The purpose of this case report is to report a case of RSE that improved after administration of Mgs4Case Illustration : A 56-year-old male patient with a history of epilepsy and left ischemic stroke, was referred with decreased consciousness after falling. The patient experienced recurrent seizures, and after treatment with diazepam and phenytoin, recurrent seizures were still found despite additional doses. After being transferred to the ICU, the patient was given therapy with midazolam, propofol, and phenobarbital, but the seizures continued to recur. After 30 hours in the ICU, MgSO4 was given intravenously two grams followed by maintenance doses. The seizures stopped and the patient remained seizure- free during the 138-hour ICU stay, with improved neurological and hemodynamic conditions.Conclusion :  MgSO4 has been shown to be effective as an anticonvulsant agent in RSE in the ICU. Its use helps stop persistent seizures and supports the patient's clinical stability. This report shows the potential of MgSO4 as a useful adjunct therapy in the management of RSE in critically ill patients.
Acute Asthma Exacerbation and Thrombocytopenia in Pregnancy: an Emergency Cesarean Case Report David, David; Aribawa, I Gusti Ngurah Mahaalit
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 6, No 1 (2026): April 2026
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v6i1.109302

Abstract

Background: Asthma exacerbation and thrombocytopenia during pregnancy present significant anesthetic challenges, particularly when urgent cesarean delivery is required. In addition, acute asthma exacerbation may compromise maternal oxygenation and necessitate immediate airway control. In such complex conditions, anesthetic management must be individualized to optimize maternal and fetal outcomes.Case Illustration: We report the case of a 26-year-old pregnant woman (G4P1021) at 38 weeks and 4 days of gestation who was referred with premature rupture of membranes, acute asthma exacerbation, and severe thrombocytopenia. On admission, the patient had mild wheezing, respiratory rate of 24 breaths per minute, and oxygen saturation ranging from 93–96% on room air. Laboratory evaluation revealed severe thrombocytopenia with a platelet count of 38 × 10⁹/L and mild anemia (hemoglobin 9.7 g/dL). Preoperative optimization included nebulized salbutamol and intravenous corticosteroids. Due to the high risk of spinal or epidural hematoma and the potential for respiratory deterioration, general anesthesia with rapid sequence induction and intubation was selected. Ketamine and propofol were used for induction to provide bronchodilation, hemodynamic stability, and reduced airway reactivity. Anesthesia was maintained with propofol infusion, fentanyl, and rocuronium. The cesarean delivery proceeded uneventfully without intraoperative bronchospasm or hemodynamic instability.Conclusion:  This case demonstrates that in obstetric emergencies complicated by acute asthma exacerbation and severe thrombocytopenia, general anesthesia can provide safer airway control and hemodynamic stability when regional anesthesia is contraindicated.

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