Pengaruh Ketamin 20 Mg Pada Bupivakain 0,5% 15 Mg Intratekal Pada Spinal Anestesi Pada Operasi Ekstremitas Bawah

Abstract

Introduction: Regional anesthesia in orthopedic procedures reduces complications associated with general anesthesia, such as nausea and aspiration pneumonia. Ketamine is effective for treating post-anesthetic shivering, although evidence regarding its use in spinal anesthesia is limited. Bupivacaine and ketamine are commonly used in spinal anesthesia, with ketamine prolonging analgesia. Adjuvants such as dexmedetomidine, fentanyl, and morphine enhance anesthetic effects, but may carry the risk of side effects such as hypotension and respiratory depression. This study aims to compare the effectiveness of intrathecal ketamine 20 mg combined with bupivacaine 0.5% 15 mg versus bupivacaine 0.5% 15 mg in patients undergoing lower extremity procedures. Methods: This randomized controlled trial (RCT), was conducted at RS Haji Medan, and Rumkit Tk II Putri Hijau Medan, Indonesia, to assess the effectiveness of intrathecal ketamine 20 mg combined with bupivacaine 0.5% 15 mg versus bupivacaine 0.5% 15 mg for spinal anesthesia in lower extremity procedures. The study evaluated differences in onset time, sensory and motor blockade duration, sedation levels, hemodynamic fluctuations, and drug-related side effects. Statistical analysis was performed using SPSS version 24.0. Results: A total of 30 patients divided into two groups: Ketamine le and Bupivacaine (n=15) and Bupivacaine (n=15). No significant differences were found in age, weight, BMI, or PS-ASA status between the two groups. A significant difference was found only in height (p=0.0148). The addition of ketamine did not significantly affect the onset or duration of sensory and motor blockade. No significant differences were observed in hemodynamic stability, heart rate, respiratory rate, or oxygen saturation between the two groups. However, the Ketamine le and Bupivacaine group experienced more side effects (7 patients) compared to the Bupivacaine group (4 patients), and had lower sedation levels. These findings suggest that the addition of ketamine prolongs the duration of spinal anesthesia but increases the risk of side effects and reduces sedation levels compared to bupivacaine alone. Conclusion: The addition of intrathecal ketamine 20 mg to bupivacaine 0.5% 15 mg significantly prolongs the duration of spinal anesthesia for lower extremity surgery but does not affect the onset time or duration of sensory blockade. Ketamine also increases the risk of side effects and reduces sedation levels compared to bupivacaine alone.