Tesis

Efektivitas tumesen dalam menurunkan jumlah perdarahan pada operasi eksisi tangensial luka bakar dewasa: tinjauan sistematis = Effectiveness of tumescent in reducing blood loss in tangential excision for adult burn patients: a systematic review.

Pendahuluan: Eksisi tangensial merupakan pembedahan yang rutin dilakukan pada pasien luka bakar, namun memiliki risiko perdarahan intraoperatif. Hal ini dapat menyebabkan meningkatnya kebutuhan transfusi dan komplikasi pascaoperasi. Berbagai metode menjadi pilihan sebagai strategi untuk menurunkan perdarahan intraoperatif, salah satunya penggunaan teknik tumesen yang mudah dan murah digunakan terutama pada Rumah Sakit dengan sumber daya terbatas. Metode: Penelitian ini merupakan tinjauan sistematis yang dilakukan sesuai pedoman PRISMA 2020. Literatur dicari pada basis data CENTRAL, MEDLINE (via PubMed), Scopus, and EBSCOhost. Studi yang diinklusi mencakup randomized controlled trials, studi kohort, dan laporan kasus yang mengevaluasi efektivitas tumesen pada pasien luka bakar dewasa yang menjalani eksisi tangensial. Data yang disektraksi berupa desain studi, demografi pasien, karakteristik luka bakar, teknik pembedahan, dan luaran berupa volume perdarahan hingga kebutuhan transfusi. Risiko bias dinilai menggunakan RoB 2.0 and ROBINS-I. Hasil: Sebanyak tujuh studi memenuhi kriteria inklusi. mayoritas studi menunjukkan bahwa teknik tumesen dengan epinefrin (1:500.000 hingga 1:2.000.000) secara konsisten menurunkan volume perdarahan intraoperatif dan kebutuhan transfusi darah tanpa meningkatkan komplikasi. Namun, terdapat perbedaan cara pengukuran satuan luaran volume perdarahan. Kesimpulan: Teknik infiltrasi tumesen dengan epinefrin terbukti efektif dan aman dalam mengurangi perdarahan intraoperatif pada pasien luka bakar dewasa yang menjalani eksisi tangensial walaupun terdapat perbedaan satuan perhitungan dan konsentrasi tumesen. Studi lanjutan multicenter dengan pengukuran volume perdarahan yang seragam diperlukan untuk memperkuat bukti efektivitas teknik ini secara lebih luas


Introduction: Tangential excision is a standard surgical approach for managing deep burns, yet it often results in considerable intraoperative blood loss. This can lead to increased transfusion needs and a higher risk of postoperative complications. Among the strategies developed to minimize bleeding, tumescent infiltration—using diluted vasoconstrictors such as epinephrine—has gained interest due to its affordability, simplicity, and applicability in resource-limited settings. Method: This systematic review followed PRISMA 2020 guidelines. Literature searches were conducted in CENTRAL, MEDLINE (via PubMed), Scopus, and EBSCOhost. Included studies comprised randomized controlled trials, cohort studies, and case series assessing the impact of tumescent infiltration on intraoperative blood loss in adult patients undergoing tangential excision. Extracted data included study design, patient demographics, burn characteristics, surgical techniques, and outcomes related to blood loss and transfusion. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools. Results: Seven studies were included for qualitative synthesis, most of which were cohort designs involving patients with full-thickness burns covering 1 –50% of Total Body Surface Area (TBSA). The use of tumescent infiltration—commonly employing epinephrine concentration between 1:500.000 until 1:2.000.000 dilution—consistently demonstrated reduced intraoperative blood loss compared to conventional techniques such as adrenaline-soaked gauze. The degree of blood loss reduction varied across studies, influenced by TBSA, unit used, surgical methods, and infiltration protocols. Conclusion: Tumescence with epinephrine is an effective and safe method for reducing intraoperative bleeding in adult burn patients undergoing tangential excision even though there are differences in measurement of bleeding and tumescent concentration. Further multicenter cohort studies with standardized blood loss measurements are needed to confirm these findings and support wider adoption.