Electronic Theses and Dissertation

Latar Belakang: Anestesi spinal merupakan teknik anestesi utama pada prosedur
seksio sesarea karena onset yang cepat, stabilitas hemodinamik yang baik, serta
risiko yang lebih rendah dibandingkan anestesi umum. Bupivakain hiperbarik
banyak digunakan karena profil barisitasnya yang memungkinkan penyebaran obat
yang lebih terprediksi di ruang subaraknoid. Kondisi intrapartum diketahui
menyebabkan peningkatan tekanan intraabdomen, kongesti pleksus vena epidural,
serta penurunan volume CSF (Cerobrospinal Fluid) yang lebih dominan daripada
pasien yang belum memasuki intrapartum. Namun, bukti komparatif antara pasien
intrapartum dan elektif masih terbatas. Penelitian ini bertujuan untuk
membandingkan onset anestesi spinal menggunakan bupivakain hiperbarik pada
pasien seksio sesarea intrapartum dan elektif.
Metode Penelitian: Penelitian ini menggunakan desain quasi-eksperimental
dengan pendekatan nonequivalent control group design. Subjek penelitian adalah
52 pasien yang menjalani seksio sesarea dengan anestesi spinal di RSUD dr.
Zainoel Abidin Banda Aceh dan RSUD Simeulue pada September–Oktober 2025,
terdiri dari 26 pasien intrapartum dan 26 pasien elektif. Seluruh pasien mendapat
bupivakain hiperbarik 0,5% dosis 10 mg yang dikombinasikan dengan fentanyl 25
μg. Variabel yang dinilai meliputi onset blok sensorik (T6), onset blok motorik
(skala Bromage 3), serta waktu pencapaian blok sensorik maksimal (≥T4).
Hasil Penelitian: Rerata onset blok sensorik kelompok elektif adalah 3,23 ± 0,82
menit, sedangkan pada kelompok intrapartum lebih cepat yaitu 1,23 ± 0,70 menit
(p < 0,05). Onset blok motorik kelompok elektif adalah 5,63 ± 1,03 menit, lebih
lambat dibandingkan kelompok intrapartum yaitu 3,40 ± 0,95 menit (p < 0,05).
Waktu pencapaian blok sensorik maksimal pada kelompok elektif adalah 5,62 ±
1,02 menit, sementara kelompok intrapartum hanya memerlukan 2,79 ± 0,93 menit
(p < 0,05). Hasil ini menunjukkan bahwa seluruh parameter onset anestesi spinal
lebih cepat pada kelompok intrapartum dibandingkan kelompok elektif.
Kesimpulan: Terdapat perbedaan bermakna onset anestesi spinal antara pasien
seksio sesarea intrapartum dan elektif. Pasien intrapartum menunjukkan onset blok
sensorik, blok motorik, dan pencapaian blok sensorik maksimal yang lebih cepat
dibandingkan pasien elektif. Perubahan fisiologis intrapartum seperti peningkatan
tekanan intraabdomen dan penurunan volume CSF diduga turut mempercepat
penyebaran bupivakain hiperbarik dalam ruang subaraknoid.
Kata Kunci: Anestesi spinal, bupivakain hiperbarik, seksio sesarea, intrapartum,
elektif, onset blok

Background: Spinal anesthesia is the primary anesthetic technique for cesarean section due to its rapid onset, stable hemodynamic profile, and lower risk compared with general anesthesia. Hyperbaric bupivacaine is widely used because its baricity allows for a more predictable spread within the subarachnoid space. Intrapartum conditions are known to cause increased intra-abdominal pressure, epidural venous plexus congestion, and a reduction in cerebrospinal fluid (CSF) volume that is more pronounced than in patients who have not entered labor. However, comparative evidence between intrapartum and elective patients remains limited. This study aimed to compare the onset of spinal anesthesia using hyperbaric bupivacaine in intrapartum versus elective cesarean section patients. Methods: This study employed a quasi-experimental design with a nonequivalent control group approach. A total of 52 patients undergoing cesarean section with spinal anesthesia at RSUD dr. Zainoel Abidin Banda Aceh and RSUD Simeulue between September and October 2025 were included, consisting of 26 intrapartum and 26 elective patients. All patients received 10 mg of 0.5% hyperbaric bupivacaine combined with 25 μg of fentanyl. Variables assessed included sensory block onset (T6), motor block onset (Bromage scale 3), and time to reach maximal sensory block (≥T4). Results: The mean sensory block onset in the elective group was 3.23 ± 0.82 minutes, while the intrapartum group demonstrated a significantly faster onset of 1.23 ± 0.70 minutes (p < 0.05). Motor block onset in the elective group was 5.63 ± 1.03 minutes, slower than the intrapartum group at 3.40 ± 0.95 minutes (p < 0.05). Time to maximal sensory block was 5.62 ± 1.02 minutes in the elective group and 2.79 ± 0.93 minutes in the intrapartum group (p < 0.05). These results indicate that all spinal anesthesia onset parameters were significantly faster in intrapartum patients. Conclusion: There is a significant difference in the onset of spinal anesthesia between intrapartum and elective cesarean section patients. Intrapartum patients exhibited faster sensory block onset, motor block onset, and time to maximal sensory block compared with elective patients. Physiological changes during labor, such as increased intra-abdominal pressure and decreased CSF volume, are presumed to contribute to the accelerated spread of hyperbaric bupivacaine in the subarachnoid space. Keywords: Spinal anesthesia, hyperbaric bupivacaine, cesarean section, intrapartum, elective, block onset.