Perbandingan Efektivitas Anestesi Spinal Menggunakan Levobupivakain dengan Atau Tanpa Fentanyl 25Mcg sebagai Adjuvan pada Pasien Seksio Sesarea

Abstract

Background: Levobupivacaine is used for spinal anesthesia and offers advantages such as a longer duration of action and lower toxicity risk compared to bupivacaine. The addition of adjuvants like fentanyl to spinal anesthesia can prolong the duration of analgesia, speed up the onset of sensory and motor blocks, and improve post-operative analgesia with minimal side effects, making it a promising choice in clinical practice for cesarean section (CS) delivery. Methodology: This study is a double-blind experimental clinical trial aimed at comparing the effectiveness of 12.5 mg levobupivacaine 0.5% and 10 mg levobupivacaine 0.5% combined with 25 mcg fentanyl in patients undergoing spinal anesthesia for cesarean section at Prof. Chairuddin P. Lubis USU Hospital and Haji Medan Hospital. Results: The sensory onset time for spinal anesthesia with levobupivacaine was 4.22 (3.02-5.03), while the combination of levobupivacaine and fentanyl was 2.90 (2.00-3.25) (p<0.05). The motor onset time for spinal anesthesia with levobupivacaine was 5.15 (4.27-5.90), while the combination with fentanyl was 2.92 (2.62-3.98) (p<0.05). The sensory duration for spinal anesthesia with levobupivacaine was 80.00 (70.00-89.00), while the combination with fentanyl was 97.00 (88.00- 104.00) (p<0.05). The motor duration for spinal anesthesia with levobupivacaine was 153.00 (141.00-165.00), while the combination with fentanyl was 119.00 (109.00-130.00) (p<0.05). The total drug satisfaction (TDS) in the levobupivacaine group was 113.00 (102.00-132.00) and the combination group was 109.00 (102.00-128.00) (p>0.05). The total drug duration (TDD) for patients post-anesthesia was 69.00 (60.00-77.00) for the levobupivacaine group and 69.00 (58.00- 81.00) for the levobupivacaine and fentanyl group (p>0.05). The mean arterial pressure (MAP) post-anesthesia was 83.60 (74.60-93.30) for the levobupivacaine group and 80.60 (74.00-96.60) for the levobupivacaine and fentanyl group (p>0.05). In the levobupivacaine group, 18.5% experienced side effects of nausea and vomiting, and 37% experienced chills. In the combination regimen group, 40.7% experienced nausea and vomiting, and 44.4% experienced chills. Conclusion: There was a significant difference in the effectiveness of spinal anesthesia using levobupivacaine with or without 25 mcg fentanyl as an adjuvant in patients undergoing cesarean section.