Penyebaran Zat Pewarna Metilen Biru di Ruang Paravertebral: Penelitian Blok Paravertebral Lumbal 4 Teknik Injeksi Satu Titik pada Kadaver

Blok paravertebral lumbal secara teori dapat dijadikan alternatif dari blok psoas dan dapat dilakukan secara blind/landmark-based. Penelitian ini bertujuan untuk mengetahui penyebaran zat pewarna pasca injeksi 1 titik di ruang paravertebral L4 terkait area pleksus lumbalis. Penelitian menggunakan kadaver segar yang tidak dikenal. Pada semua kadaver dilakukan penyuntikan 30 mL zat pewarna metilen biru 1% pada injeksi 1 titik di ruang paravertebral L4 menggunakan jarum blok standar, kemudian dilakukan diseksi untuk mengetahui penyebaran zat pewarna tersebut. Penelitian ini mengikutsertakan 16 kadaver yang memenuhi syarat. Didapatkan penyebaran terjauh ke arah sefalad mencapai level L1 (6,25%) dengan rata-rata mencapai level L3 (50%). Penyebaran terjauh ke arah kaudad mencapai level S2 (12,5%) dengan rata-rata mencapai level L5 (56,25%). Penyebaran kontralateral sebanyak 18,75%. Penyebaran segmental paling sedikit sebanyak 2 segmen (6,25%), paling banyak sebanyak 5 segmen (12,5%), dan sebaran segmental terbanyak (43,75%) ialah sebanyak 4 segmen. Injeksi 1 titik 30 mL metilen biru 1% pada blok paravertebral L4 dapat mencapai area pleksus lumbalis. Penelitian lebih lanjut diperlukan untuk mengetahui volume optimal serta lokasi injeksi teraman dan efektif untuk menghasilkan penyebaran yang lebih baik pada pleksus lumbalis maupun pleksus lumbosakral. Kata kunci: Blok paravertebral, blok psoas, kadaver, metilen biru, pleksus lumbalis Lumbar paravertebral block theoretically can be used as an alternative for psoas block, furthermore it can be done with a landmark-based technique. The object of this study was to determine the spreading of 30 ml 1% methylene blue dye after single point injection in the L4 lumbar paravertebral space, regarding the area of lumbar plexus. The study used fresh unclaimed cadavers. On all cadavers, a single dose of 30 mL 1% methylene blue injected in the L4 lumbar paravertebral space, using a standard b-bevel needle. Then the cadavers dissected on lumbar area to determine the spreading of the methylene blue. Sixteen cadavers which met the criteria were included. The most cephalad spread was at L1 level (6.25%) with average at the L3 level (50%). The most caudad spread was at the S2 level (12.5%) with average at the L5 level (56.25%). The contralateral spread was found in 18.75% of cadavers. The minimal segmental spread were 2 segments (6.25%) and the maximum segmental spread were 5 segments (12.5%), and the average segmental spread were 4 segments (43.75%). Single point injection of 30 mL 1% methylene blue in the L4 lumbar paravertebral space can cover the lumbar plexus area. Further studies are needed to determine the optimal volume, the effective and safer site for injection technique to produce better spread in the lumbar plexus and lumbosacral plexus innervation as well. Keywords: Cadaver, methylene blue, lumbar plexus, paravertebral block,psoas block Reference Hala.