Comparing Three Different Modified Sitting Positions for Ease of Spinal Needle Insertion in Patients Undergoing Spinal Anesthesia

Abstract

BackgroundThe most important point for performing a neuroaxial block in a sitting position is reducing lumbar lordosis, resulting in easier access to interspinous space and dura mater. There are a few studies comparing 2 different sitting positions including a traditional sitting position (TSP) versus forward bending or hamstring stretch position (HSP) as well as TSP versus squatting position (SP) for reversing the lumbar lordosis and improving access to intervertebral space for neuroaxial block.ObjectivesWe compared 3 different sitting positions including traditional sitting position vs. hamstring stretch position vs. squatting position and hypothesized that squatting position reverses the lumbar lordosis and reduces the number of spinal needle bone contacts more than TSP and HSP.MethodsA total of Thirty hundred and sixty ASA class I or II patients aged 18 to 60 years were scheduled for elective surgeries under spinal anesthesia were randomized into 3 groups. Our primary endpoint was the number of spinal needle-bone contacts and our secondary endpoint was ease of needle insertion or space identification.ResultsDemographic data were statistically different between the study groups. There was no statistical difference between the study groups regarding the number of needle bone contacts and the ease of finding intervertebral space (P = 0.63, P = 0.56, respectively).ConclusionsThere was no statistical difference between the TSP, HSP, and SP regarding the number of needle bone contacts and the ease of finding of intervertebral space. In this regard, each of these 3 positions can be used as an alternative sitting position for administration of spinal anesthesia.

The ‘Cross-Legged Foetal Sitting Neuraxial Position’: Is it Beneficial?-A Prospective Randomised Clinical Trial Via Ultrasonography

“…Several kinds of neuraxial positioning techniques, such as lateral, traditional sitting, hamstring stretch, sitting legs parallel on the table, pendant, Oxford and mid-calf, have been recently evaluated by USG ( 3 , 4 , 14 – 16 ). Within those positioning techniques, the traditional sitting position (TSP) appears to be a better choice for ease and success of the manoeuvre.…”

Comparison of successful spinal puncture between pendant position and traditional sitting position for cesarean deliveries

“…Poor positioning can result into multiple needle pricks and needle-to-bone contacts, thus increasing risk of backache, epidural hematoma, neural trauma and post-dural puncture headache (PDPH). [5][6][7][8] Lumbar spine curvature increases significantly in the last trimester of pregnancy, shifting center of gravity towards abdomen causing lumbar hyperlordosis. 9 Hyperlordosis produces vertebral space narrowing; while lumbar flexion is difficult to achieve in pregnant patients making median approach for spinal puncture very difficult.…”

“…8 Fisher et al claimed that number of needle-to-bone contacts was equal in both positions during epidural labor analgesia. 6,11 Ease of spinal access was studied in population other than pregnant females by Soltani Mohammadi et al, they found that needle-bone contacts were lower in SP than TSP (222 vs. 230 respectively, p = 0.01). 6,12 In a study by Tashayod et al, HSP was marked as the best position for reducing lumbar lordosis, they also studied non-pregnant population coming for lower abdominal and lower limb surgeries.…”

“…6,11 Ease of spinal access was studied in population other than pregnant females by Soltani Mohammadi et al, they found that needle-bone contacts were lower in SP than TSP (222 vs. 230 respectively, p = 0.01). 6,12 In a study by Tashayod et al, HSP was marked as the best position for reducing lumbar lordosis, they also studied non-pregnant population coming for lower abdominal and lower limb surgeries. 6,13 Best sitting position for performing spinal block is still unknown, especially in pregnant females.…”

“…6,12 In a study by Tashayod et al, HSP was marked as the best position for reducing lumbar lordosis, they also studied non-pregnant population coming for lower abdominal and lower limb surgeries. 6,13 Best sitting position for performing spinal block is still unknown, especially in pregnant females. Pendant position helps to reduce lumbar hyperlordosis seen in pregnant females making spinal access easier and minimizing multiple attempts.…”