Tesis

Perbandingan Crossed Leg Sitting Position dan Traditional Sitting Position terhadap Keberhasilan Penempatan Jarum Spinal pada Pasien Bedah Urologi = Comparison of crossed leg sitting position and traditional sitting position to successful insertion of spinal needle for patient undergoing urologic surgery procedure.

Latar Belakang: Posisi pasien selama tindakan anestesia spinal menentukan keberhasilan penempatan jarum spinal. Traditional sitting position (TSP) merupakan posisi standar untuk anestesia spinal, namun angka keberhasilannya masih cukup rendah. Crossed leg sitting position (CLSP) merupakan salah satu posisi alternatif dalam anestesia spinal yang memiliki kelebihan berupa derajat fleksi lumbal yang lebih besar. Penelitian ini bertujuan untuk membandingkan CLSP dan TSP terhadap keberhasilan penempatan jarum spinal pada pasien bedah urologi Metode: Penelitian ini adalah uji klinik acak tidak tersamar terhadap pasien yang menjalani anestesia spinal untuk prosedur urologi pada bulan Maret-April 2015 di RSUPN dr. Cipto Mangunkusumo. Setelah mendapatkan persetujuan izin etik dari Komite Etik Penelitian Kesehatan FKUI-RSCM, sebanyak 138 subjek dialokasikan ke dalam dua kelompok posisi penusukan jarum spinal yaitu kelompok CLSP dan TSP. Proporsi keberhasilan penempatan jarum spinal di rongga subarakhnoid, kemudahan perabaan landmark, dan jumlah needle-bone contact pada kedua kelompok kemudian dinilai.
Hasil: Enam subjek masuk kriteria pengeluaran berupa kegagalan penempatan jarum spinal setelah lebih dari sembilan kali percobaan. Tersisa 132 subjek, 67 subjek pada kelompok CLSP dan 65 subjek pada kelompok TSP, yang berhasil menyelesaikan penelitian. Keberhasilan penempatan jarum spinal secara one shot pada kelompok CLSP dan TSP tidak berbeda bermakna (64.2% vs 53.8%, p=0.227). Kemudahan perabaan landmark pada kelompok CLSP berbeda bermakna dengan TSP (94% vs 75%, p=0.003). Jumlah needle-bone contact pada kedua kelompok tidak berbeda bermakna (p=0.337) Simpulan: Keberhasilan penempatan jarum spinal pada kelompok CLSP tidak berbeda bermakna dibandingkan dengan keberhasilan penempatan jarum spinal pada kelompok TSP pada pasien bedah urologi
Kata kunci: Crossed leg sitting position, jumlah needle-bone contact, penempatan jarum spinal, perabaan landmark, traditional sitting position



Background: Patient position during spinal anesthesia plays a major role in determining the success of spinal needle insertion to subarachnoid space. Traditional sitting position (TSP) is a standard position for spinal anesthesia, but the success rate for spinal anesthesia in TSP is still quite low. Crossed leg sitting position (CLSP) is one of the alternative positions in spinal anesthesia, which can increase the degree of lumbar flexion. This study aimed to compare CLSP and TSP to the successful insertion of spinal needle in urologic surgery patients
Methods: This study was a non-blinded randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures between March-April 2015 in RSUPN dr. Cipto Mangunkusumo. After obtaining approval from FKUI-RSCM Ethical Committee, 138 subjects were allocated into two groups, CLSP group and TSP group. The proportion of successful spinal needle insertion to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contact in both groups were then analyzed and assessed.
Result: Six subjects met dropout criteria, which was failure of obtaining successful spinal needle insertion after nine consecutive redirections. The remaining 132 subjects, 67 subjects in the CLSP group and 65 subjects in TSP group, successfully completed the study. The proportion of successful spinal needle insertion in a one-time shot, was not significantly different between CLSP and TSP group (64.2% vs. 53.8%, p = 0227). Ease of landmark palpation in CLSP group was significantly different with TSP group (94% vs. 75%, p = 0.003). The number of needle-bone contact in both groups was not significantly different (p = 0337)
Conclusion: The proportion of successful spinal needle insertion in CLSP group was not significantly different compared to TSP group for urologic surgery patients
Keywords: Crossed leg sitting position, landmarks, number of needle-bone contact, spinal needle insertion, traditional sitting position.