Skripsi

Seri Kasus Tindakan Bedah Mikro Rekonstruksi Tangan dengan Anestesi Lokal Sadar Penuh Tanpa Turniket di Rumah Sakit Umum Pusat Rujukan Nasional Dr. Cipto Mangunkusumo pada Tahun 2017- 2024 = Case Series of Hand Reconstructive Microsurgery Under WALANT at Dr. Cipto Mangunkusumo National Referral Hospital During 2017– 2024.

Latar Belakang Teknik Wide Awake Local Anaesthesia No Tourniquet (WALANT) memungkinkan tindakan bedah tangan dilakukan tanpa anestesi umum dan tanpa turniket, sehingga pasien tetap sadar dan dapat dievaluasi fungsinya secara langsung selama operasi. Meskipun banyak digunakan secara global, data mengenai penerapan teknik ini pada tindakan bedah mikro rekonstruksi tangan di Indonesia masih terbatas. Metode Penelitian ini merupakan kajian deskriptif retrospektif terhadap seluruh kasus tindakan bedah mikro rekonstruksi tangan dengan pasien sadar penuh menggunakan teknik anestesi lokal sadar penuh tanpa turniket di RSUPN Dr. Cipto Mangunkusumo pada periode 2017–2024. Data dikumpulkan dari rekam medis pasien yang memenuhi kriteria inklusi, meliputi karakteristik pasien, jenis tindakan, teknik anestesi, nyeri intraoperatif, serta luaran pascaoperatif berupa viabilitas jaringan, fungsi tangan, dan waktu pemulihan. Hasil Diperoleh tiga kasus yang memenuhi kriteria, meliputi cedera kompleks seperti spaghetti wrist, puntung amputasi jari, dan avulsi jaringan akibat trauma tajam. Seluruh tindakan dilakukan dengan teknik WALANT menggunakan larutan lidokain 0,2% dan epinefrin 1:1.000.000 tanpa turniket. Nyeri intraoperatif rendah (NRS 0–3), tidak ditemukan komplikasi, dan seluruh jaringan menunjukkan viabilitas baik. Pasien menunjukkan pemulihan fungsi motorik dan sensorik, dengan waktu kembali bekerja rata-rata enam bulan pascaoperasi. Kesimpulan Teknik anestesi lokal sadar penuh tanpa turniket terbukti aman dan efektif diterapkan pada tindakan bedah mikro rekonstruksi tangan di RSCM.
Kata Kunci: WALANT, bedah mikro, lidokain, epinefrin, flap bebas, spaghetti wrist


Introduction The Wide-Awake Local Anaesthesia No Tourniquet (WALANT) technique allows hand surgery to be performed without general anaesthesia or tourniquet, enabling the patient to remain fully conscious and permitting direct intraoperative evaluation of tendon movement and tissue perfusion. Although widely adopted worldwide, data on its application in hand microreconstructive surgery in Indonesia remain limited. Method This study is a retrospective descriptive review of all cases of hand microreconstructive surgery performed under local anaesthesia without tourniquet at Dr. Cipto Mangunkusumo General Hospital from 2017 to 2024. Data were collected from medical records of patients meeting the inclusion criteria, including patient characteristics, type of procedure, anaesthetic technique, intraoperative pain scores, and postoperative outcomes such as flap viability, hand function, and recovery time. Results Three cases met the inclusion criteria, comprising complex injuries such as spaghetti wrist, partial finger amputation, and soft-tissue avulsion due to sharp trauma. All procedures were performed using the WALANT technique with 0.2% lidocaine and 1:1,000,000 epinephrine without a tourniquet. Intraoperative pain was minimal (NRS 0– 3), with no complications, and all flaps demonstrated good viability. Patients achieved satisfactory motor and sensory recovery, with an average return-to-work time of six months postoperatively. Conclusion The use of local anaesthesia without tourniquet is proven to be safe and effective for hand reconstructive microsurgery at Dr. Cipto Mangunkusumo General Hospital.
Keywords: WALANT, microsurgery, lidocaine, epinephrine, free flap, spaghetti wrist