EPIDURAL BUPIVACAINE 0,25% MENURUNKAN KONSUMSI OPIOID PADA PASIEN PEDIATRI DENGAN WILMS TUMOR YANG MENJALANI NEFREKTOMI RADIKAL PER LAPAROSKOPI : SEBUAH LAPORAN KASUS
DOI:
https://doi.org/10.31004/prepotif.v9i2.45654Keywords:
bupivacaine, epidural, laparoskopi, pediatri, tumor wilmsAbstract
Wilms Tumor (WT) merupakan tumor ginjal ganas tersering pada anak, dengan prevalensi 2-6% dari kasus keganasan anak. Pendekatan minimal invasif dengan laparoskopi menjadi pilihan terapi. Penggunaan anestesi epidural dengan bupivacaine menjadi salah satu pilihan manajemen nyeri multimodal yang dapat meningkatkan kenyamanan, menstabilkan hemodinamik, serta menurunkan kebutuhan opioid. Kami melaporkan kasus anak perempuan 5 tahun dengan massa ginjal kiri sesuai WT yang telah mendapat 12 seri kemoterapi. Pasien menjalani nefrektomi radikal per laparoskopi dengan anestesi umum kombinasi analgesia epidural. Induksi menggunakan sevoflurane, fentanyl, atracurium, dan pemeliharaan dengan sevoflurane 2-2,5%. Kateter epidural dipasang dengan bupivacaine 0,25% untuk analgesia perioperatif. Operasi dikonversi menjadi laparotomi terbuka karena adhesi dan hematoma renal. Hemodinamik tetap stabil selama 8 jam operasi, dengan perdarahan 200 ml. Nyeri pascaoperasi dikelola dengan bupivacaine 0,1% + morfin epidural dan parasetamol. Penggunaan anestesi epidural bupivacaine 0,25% memberikan stabilitas hemodinamik selama operasi. Analgesia epidural multimodal dengan morfin memperpanjang efek analgesik pascaoperasi, mengurangi kebutuhan opioid sistemik, mempercepat ekstubasi dan pemulihan. Pemantauan ketat di PICU diperlukan untuk mendeteksi komplikasi. Penggunaan anestesi epidural sebagai modalitas tambahan pada nefrektomi Wilms Tumor efektif menstabilkan hemodinamik intraoperatif, mengoptimalkan kontrol nyeri pascaoperasi, serta mendukung pemulihan pasien yang lebih cepat dan nyaman.References
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