Comparative Study of Effect of Spinal Anesthesia in Sitting and Lateral Positions on the Onset Time of Sensory Block and Hemodynamic Condition in Cesarean Section: A Randomized Clinical Trial

Abstract

Background: Spinal anesthesia is the method of choice for the cesarean section. Hypotension is a common complication of this method. Objectives: This study aimed to compare the effect of spinal anesthesia in the sitting and lateral positions on the onset time of sensory block and hemodynamic condition in cesarean sections. Methods: In this clinical trial, 106 elective cesarean section candidates under spinal anesthesia were selected and randomly divided into two groups: spinal anesthesia in the sitting position (group S) and the lateral position (group L). The onset time of the sensory block, quality of sensory and motor block, hemodynamic condition, frequency of hypotension, nausea, and vomiting, and the doses of ephedrine and atropine were compared between both groups. Data were analyzed with SPSS version 16 software at a 95% confidence level. Results: There was no statistically significant difference between the two groups in terms of age. The frequency of hypotension in L and S groups was 24.5% and 57.7%, respectively (P = 0.001), in minute 6 after spinal anesthesia and 5.7% and 36.5%, respectively (P < 0.001), in minute 8 after spinal anesthesia. The mean time to reach the sensory level of T6 was 1.30 ± 0.43 min versus 4.54 ± 2.12 min (P < 0.001), motor block score in minute 5 was 2.98 ± 0.14 versus 2.82 (P = 0.044), and ephedrine dose was 11.5 mg and 16.92 mg in the L and S groups, respectively (P = 0.010). The maximum sensory-motor block and satisfaction of women with spinal anesthesia were significantly higher in the lateral position than in the sitting position (P < 0.05). Conclusions: Cesarean sections under spinal anesthesia in the lateral position than in the sitting position lead to a more rapid sensory and motor block, reduced ephedrine consumption, and enhanced satisfaction of women.

Mepivacaine Versus Bupivacaine in Adult Surgical Patients: A Meta-analysis, Trial Sequential Analysis of Randomized Controlled Trials

“…Secondly, a variety of factors, such as mode of anesthesia, dosage, density, type of needles, different standards for function recovery, and the patient position may affect clinical outcomes. [35][36][37] In addition, adding epinephrine and fentanyl to intrathecal or locoregional local anesthetics affected analgesia and motor block. [38][39][40][41][42][43][44] When the total maximum dose of bupivacaine exceeds 90 mg and mepivacaine exceeds 300 mg, localized nerve injury to systemic cardiovascular toxicity occurs.…”

Effect of Different Positions During Surgical Preparation With Combined Spinal-Epidural Anesthesia for Elective Cesarean Delivery: A Randomized Controlled Trial

“…Both groups, Lee et al2 and Liu et al4 used relatively large doses of intrathecal hyperbaric bupivacaine, 12 and 12.5 mg, respectively. Initiation of spinal anesthesia lateral position leads to a more rapid onset of block by up to 3 minutes, when compared with the sitting position 6. Choosing the sitting position would therefore prolong the duration of the patient being in 30 degrees left lateral position.…”

“…Initiation of spinal anesthesia lateral position leads to a more rapid onset of block by up to 3 minutes, when compared with the sitting position. 6 Choosing the sitting position would therefore prolong the duration of the patient being in 30 degrees left lateral position. If this has a clinically relevant effect on the distribution of hyperbaric bupivacaine is not known, not with intermediate and not with low doses of intrathecal local anesthetics.…”

Validación de la posición de Vallejo por ultrasonografía para acceso neuroaxial difícil en pacientes obstétricas

“…l abordaje neuroaxial es la técnica de elección en la práctica anestésica dentro del campo de la obstetricia dado que presenta ventajas como la reducción de complicaciones cardíacas en pacientes de riesgo, el mantener la autonomía respiratoria, menor afectación de la inmunidad, entre otras [1], [2]. Sin embargo, las enfermedades crónico-degenerativas, el sobrepeso, la obesidad mórbida, las deformidades músculo esqueléticas congénitas o por trauma y los cambios fisiológicos propios del embarazo hacen que el anestesiólogo se enfrente muchas veces a procedimientos de difícil acceso del neuroeje.…”

“…En ocasiones se realizan múltiples intentos, lo que constituye un factor de riesgo, por un lado, para el profesional que se enfrenta a una crisis al tener dificultad en la ejecución de la técnica, y por otro lado, en la paciente que manifiesta ansiedad, dolor, disconfort y en ocasiones síntomas vágales etc. Si se logra el bloqueo tras varios intentos fallidos, se podría hacer evidente: dolor lumbar, cefalea pospunción, parestesias que indican daño de la fibra nerviosa; todo ello engloba una experiencia desagradable para el paciente [3], [1], [2],4].…”