Dexmedetomidine pada Blok Torakolumbar Interfasial Plane Modifikasi: Tinjauan Naratif
DOI:
https://doi.org/10.24843/s4tbj786Keywords:
Analgesia pascaoperasi, Bedah tulang belakang, Blok TLIP, Blok torakolumbar interfasial, DexmedetomidineAbstract
Nyeri pascaoperasi merupakan tantangan klinis utama pada pasien yang menjalani bedah tulang belakang lumbal. Pendekatan analgesia multimodal semakin berkembang, dan blok interfasial torakolumbal (Thoracolumbar Interfascial Plane/TLIP) menjadi salah satu teknik yang efektif dalam mengurangi nyeri dengan risiko minimal terhadap fungsi motorik. Modifikasi teknik TLIP, terutama dengan penambahan adjuvan seperti dexmedetomidine, menawarkan potensi peningkatan durasi dan kualitas analgesia.
Tinjauan naratif ini bertujuan merangkum bukti terkini mengenai efektivitas, mekanisme, dan keamanan penggunaan dexmedetomidine sebagai adjuvan pada TLIP modifikasi untuk bedah lumbal. Pencarian literatur dilakukan melalui basis data PubMed, Scopus, dan Google Scholar dengan menggunakan kata kunci “modified TLIP block”, “dexmedetomidine”, “lumbar spine surgery”, dan “postoperative analgesia” untuk artikel berbahasa Inggris atau Indonesia yang diterbitkan antara tahun 2013 hingga 2024.
Hasil sintesis menunjukkan bahwa penambahan dexmedetomidine (0,5–1 µg/kg) pada anestesi lokal dapat memperpanjang durasi analgesia hingga 6–8 jam, menurunkan skor nyeri pascaoperasi, serta mengurangi konsumsi opioid tanpa menimbulkan efek samping berat, seperti bradikardia atau hipotensi yang signifikan. Efek analgesik ini terkait dengan aktivasi reseptor α₂-adrenergik di perifer dan spinal yang menghambat transmisi nyeri.
Tinjauan ini membahas secara komprehensif dasar fisiologi dan farmakologi kombinasi TLIP–dexmedetomidine, perbandingan dengan blok interfasial lain, bukti klinis terkini, serta arah penelitian yang diperlukan untuk penerapan optimal dalam praktik anestesiologi modern.
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