PAINLESS

Bupivacaine vs Lidocaine
LABOR
HypnoBirthing

Stigma ?

Delivery of the infant into the arms of a conscious and pain-free

mother is one of the
most exciting and rewarding moments in medicine.

KOMPLEKSITAS NYERI
PERSALINAN

Nyeri dan Stress

Maternal
Hiperventilasi
Maternal

Pelepasan
katekolamin dan
kortisol

Respiratori Alkalosis

Vasokonstriksi
Uterus

Pergeseran kurva
disosiasi oksigen ke
kiri

Penurunan aliran
darah plasenta

Penurunan transfer oksigen ke fetus asidosis

metabolik fetal

PATOFISIOLOGI NYERI
PERSALINAN

NYERI PERSALINAN
NYERI
VISERAL

NYERI
SOMATIK

Kala I Persalinan

Kala II Persalinan

T10 L1

S2 S4

Distensi dan Peregangan

Segmen Bawah Uterus

Distensi Pelvis dan Struktur

Perineum dan Kompresi Plexus
LS

JALUR
SARAF
PADA

NYERI
PERSALINAN

NYERI VISERAL / NYERI

SOMATIK

Viser
al
Viseral

Somatik

PILIHAN INTERVENSI NEURAXIAL

Advantages vs Disadvantages

Gold
Standard

Time vs

IDEAL OBSTETRIC
ANALGESIC
Mengatasi kecemasan maternal,
kelelahan, dan melahirkan bayi yang
sehat
Obat-obatan tidak melawati sawar
plasenta
Efek minimal terhadap fetus, ibu, atau
neonatus
Dapat diberikan pada fase akhir
persalinan

Jalur pemberian mudah

IDEAL OBSTETRIC
ANALGESIC
Reversible
Tidak ada efek motorik
Mampu mempertahankan aliran
darah uterus

EPIDURAL KALA I
Pilihan regimen epidural bolus; Bupivacaine
0.125%, Bupivacaine 0.25%
Epidural bolus 5 -10 mL (Bupivacaine 0.25%),
diikuti rumatan 8-12 mL/jam (Bupivacaine
0.625%)
Target blok:
Kala I: T10-L1
Kala II: S2-S4

Ajuvan; fentanyl 1-2 ug/mL, sulfentanil 0.3-0.5

ug/mL (Berlaku sebagai penguat blok dan dilusi
dari regimen anestesi lokal yang diberikan)

EPIDURAL KALA II
Pilihan regimen epidural bolus;
Bupivacaine 5%, Lidocaine 1%
Epidural bolus 10 mL, rumatan Target blok S2-4
Ajuvan; -

SPINAL KALA I & II

Pilihan regimen epidural bolus;
Bupivacaine 0.25%
Caudal spinal bolus 1 mL, rumatan Target cek sensasi blok (T10-L1)
Ajuvan; fentanyl 10ug, sulfentanil 2-5
ug

Combined Spinal-Epidural
Analgesia
Onset cepat (2-5 menit dibandingkan
dengan 10-15 menit pada teknik lain)
Mengurangi insidensi kegagalan analgesia
epidural (penempatan kateter)
Kemungkinan komplikasi: Infeksi
neuraxial postpartum
Penempatan kateter epidural yang belum
dapat dipastikan selama 1 sampai 2 jam
setelah inisiasi

BUPIVACAINE
Anestetik lokal golongan amida
Sangat protein-bound minimal
transfer transplasental
Onset analgesia: 8 10 menit
MLAC: fase awal < fase akhir
persalinan
Low concentration-high volume

LIDOCAINE
Anestetik lokal golongan amida
Lidocaine 0.75% - 1.0%
memberikan efek analgesia yang
baik
Durasi kerja pendek tidak untuk
inisiasi atau maintenance analgesia
Less protein-bound
Abnormal neurobehavioral neonatus

PERMINTAAN BIUS

2 better than 1

Over Expectation

Cegahlah!

Problema ?

So ?

Kepustakaan
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A.M. MICHAEL. (1952). Hypnosis in Childbirth. British Medical Journal. p. 734-737.
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