Tesis

Pengaruh Pemberian Infus Ketamin Subanestetik Terhadap Kebutuhan Fentanil Intrabedah Dalam Anestesi Umum Pembedahan Tulang Belakang = The Effect of Subanesthetic Ketamine Infusion on Intraoperative Fentanyl Requirements in Spine Surgery Under General Anesthesia.

Latar Belakang: Pembedahan tulang belakang merupakan prosedur yang menimbulkan stimulus nosiseptif sehingga membutuhkan manajemen analgesia yang optimal. Respons simpatis stimulus pembedahan umumnya ditangani menggunakan opioid, namun memiliki resiko dan efek samping. Pemberian ketamin dosis subanestetik diketahui berpotensi mengurangi kebutuhan opioid intrabedah melalui mekanisme modulasi nyeri sentral. Metode: Uji klinis acak tersamar ganda pada 36 pasien berusia 18 hingga 60 tahun dengan ASA I-III yang menjalani pembedahan tulang belakang di RSCM (April hingga Agustus 2025). Subjek dibagi menjadi dua kelompok: ketamin dosis subanestetik 0,5 mg/kg/jam intravena dan kelompok kontrol. Pemantauan intrabedah meliputi qNox, qCon, hemodinamik, serta kebutuhan fentanil tambahan. Evaluasi NRS, kejadian delirium, dan efek samping fentanil dan ketamin dilakukan hingga 1 jam pascaoperasi. Analisis dilakukan menggunakan uji komparatif dengan signifikansi p < 0,05. Hasil: Ketamin dosis subanestestik tidak menurunkan kebutuhan fentanil tambahan intrabedah secara signifikan (p=0,149). Pengukuran qNpx, qCon, NRS, kejadian delirium 1 jam pasca operasi, serta efek samping tidak menunjukkan perbedaan signifikan antara kedua kelompok. Kesimpulan: Ketamin dosis subanestetik intrabedah tidak menurunkan kebutuhan fentanil intrabedah. Penelitian lanjutan diperlukan untuk menentukan dosis dan durasi optimal guna meningkatkan efek terhadap kebutuhan opioid dan respons nosiseptif perioperatif.
Kata kunci: fentanil; ketamin subanestetik; NRS; pembedahan tulang belakang; qNox


Introduction: Spine surgery induces significant nociceptive stimuli, requiring optimal analgesic management. Surgical sympathetic responses are commonly managed with opioids; however, their use is associated with risks and side effects. Subanesthetic ketamine administration has been reported to reduce intraoperative opioid requirements through central pain modulation mechanisms. Methods: A double-blind randomized clinical trial was conducted on 36 patients aged 18–60 years with ASA I–III undergoing spine surgery at RSCM from April to August 2025. Subjects were assigned to either a subanesthetic ketamine group (0.5 mg/kg/h intravenously) or a control group. Intraoperative monitoring included qNox, qCon, hemodynamic parameters, and supplemental fentanyl requirements. Postoperative assessment included NRS scores, delirium incidence, and ketamine or fentanyl-related adverse effects up to 1 hour after surgery. Data were analyzed using comparative tests with a significance level of p < 0.05. Results: Subanesthetic ketamine did not significantly reduce supplemental intraoperative fentanyl requirements (p = 0.149). No significant differences were found between groups in qNox, qCon, NRS scores, postoperative delirium at 1 hour, or adverse effects. Conclusion: Intraoperative subanesthetic ketamine did not reduce intraoperative fentanyl requirements. Further studies are needed to determine optimal dosing and duration to improve effects on perioperative opioid needs and nociceptive responses.
Keywords: fentanyl; subanesthetic ketamine; NRS; spine surgery; qNox