Tesis

Perbandingan Adjuvan Anestesia Spinal dengan Blok Quadratus Lumborum pada Laparoskopi Donor Transplantasi Ginjal terhadap Kebutuhan Opioid dan Nyeri Perioperatif = Comparison between Spinal Anesthesia Adjuvant to Quadratus Lumborum Block in Renal Donor Transplantation Laparoscopy to Perioperative Opioid and Pain Scale.

Pendahuluan: Laparoscopic Living-Donor Nephrectomy merupakan prosedur standar transplantasi ginjal donor hidup dengan managemen nyeri perioperatif multimodal untuk fasilitasi pemulihan dini dan mengurangi opioid. Blok quadratus lumborum (QL) efektif dalam mengontrol nyeri tetapi membutuhkan fasilitas khusus. Anestesia spinal dengan tambahan opioid intratekal menjadi alternatif prosedur yang lebih mudah. Penelitian ini bertujuan untuk membandingkan blok QL dan spinal terhadap nyeri dan kebutuhan opioid perioperatif. Metode: Penelitian ini merupakan studi eksperimental acak tersamar tunggal. Sebanyak 55 subjek penelitian donor transplantasi ginjal di RSUPN Cipto Mangunkusumo pada periode Februari 2025 – Januari 2026 yang dimasukkan ke kelompok blok QL dan spinal secara acak. Luaran penelitian berupa penggunaan fentanyl intraoperatif, morfin pascaoperasi, dan derajat nyeri saat istirahat dan bergerak pascaoperasi. Hasil: Terdapat 1 subjek drop out sehingga 54 subjek (27 subjek per kelompok) yang dianalisis. Penggunaan fentanyl intraoperatif tidak berbeda (p 0,512) pada kedua kelompok (median 2 (2-3) mcg/kg). Derajat nyeri NRS saat istirahat (median 1) dan saat bergerak (median 2-3) pada kedua kelompok tetapi tanpa perbedaan bermakna meskipun nilai p 0,049 pada nyeri saat bergerak jam ke-12 dengan perbedaan median 1 (0-1). Penggunaan morfin 24 jam pascaoperasi (p 0,013) di kelompok blok QL 2 (2-4) mg dan spinal 0 (0-2) mg tetapi tanpa perbedaan bermakna dengan perbedaan median 2 (0-4). Namun, persentase penggunaan morfin PCA 24 jam pascaoperasi berbeda (p 0,006) dengan kelompok blok QL 77,8% dan spinal 40,7%. Simpulan: Penelitian ini tidak menunjukkan perbedaan antara kedua kelompok dalam fentanyl intraoperatif, derajat nyeri saat istirahat maupun bergerak, dan kebutuhan morfin 24 jam pascaoperasi. Namun, persentase subjek menggunakan morfin PCA berbeda antara kedua kelompok.
Kata kunci: anestesia spinal; blok quadratus lumborum; laparoskopi nefrektomi donor; morfin intratekal; nyeri


Background: Laparoscopic living-donor nephrectomy (LLDN) is the standard procedure for living-donor kidney transplantation with multimodal analgesia approach for optimal recovery and minimize opioid consumption. The Quadratus Lumborum (QL) block is effective to provide pain control but require special facility. Spinal anesthesia with intratechal morphine adjuvant is an alternative technique which is a simpler procedure and to ensures adequate block and pain control. This study aims to compare QL block and spinal anesthesia regarding perioperative opioid and pain scale. Methods: This study was a single-blind, randomized-controlled trial. A total of 55 kidney transplant donors at RSUPN Cipto Mangunkusumo between February 2025 and January 2026 were randomly assigned to either QL block or spinal anesthesia group. Research outcomes included intraoperative fentanyl dosage, postoperative morphine consumption, and postoperative NRS pain scales at rest and during movement. Results: Following 1 dropout, 54 subjects (27 per group) completed the study and were included in the analysis. There is no differences in intraoperative fentanyl consumption (p 0,512) with 2 (2-3) mcg/kg in both groups. NRS pain scores at rest (median 1) and during movement (median 2-3) in both groups but without differences between group although p value 0,049 in 12 hours postoperative pain scores during movement but median differences 1 (0-1). Postoperative 24-hour morphine consumption (p 0,013) was 2 (2-4) mg in the QL block grup and 0 (0-2) mg in spinal group but without differences with median difference 2 (0-4). However, percentages of morphine PCA usage between two groups was statistically different (p 0,006) with QL block group 77,8% and spinal group 40,7%. Conclusion: This study found no statistically significant differences between QL block and spinal anesthesia groups in terms of intraoperative fentanyl consumption, postoperative NRS pain scores at rest and during movement and the 24-hour morphine consumption. However, a significant difference was identified in PCA usage proportion.
Keywords: intratechal morphine; laparoscopic living-donor nephrectomy; pain; quadratus lumborum block; spinal anesthesia