Comparison of haemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for elective caesarean section

Abstract

Background: Spinal anaesthesia avoids the problems associated with general anaesthesia such as airway manipulation, polypharmacy, postoperative respiratory problems, and cognitive dysfunction. It can be given in lateral and sitting positions. The aim of the present study was to compare the effect of induction position for spinal anaesthesia in elective caesarean section on hemodynamic, sensory and motor block characteristics and patient satisfaction.Methods: 120 ASA physical status I and II patients undergoing elective caesarean section were randomized to receive spinal anaesthesia in the lateral position or the sitting position. Hyperbaric bupivacaine (0.5%) was injected into the spinal space while the patients were either in sitting or lateral position at L3-L4 level. Effects on hemodynamic parameters, sensory block and motor block characteristics and patient satisfaction were analysed.Results: Demographic characteristics did not seem to have any impact on the overall outcome of the study. Induction position for spinal anaesthesia does not affect the hemodynamic parameters and incidence of side effects when adequate preloading is done. There was no statistically significant difference in the sensory level and motor level achieved. However lateral position appears to be more comfortable than sitting position (P <0.001).Conclusions: Inducing position for spinal anaesthesia did not affect haemodynamic stability and block characteristics in both the groups except that patients feel more comfortable in lateral position.

Comparison of the effect of induction position in spinal anaesthesia on sensory block in pregnant women undergoing elective lower segment caesarean section with hyperbaric bupivacaine

“…In our study, it was found that in sitting position, 53.1% of the patients and in left lateral decubitus position, 40.6% of the patients required ephedrine supplementation but the difference was comparable. The ephedrine requirements were comparable in both sitting and lateral groups as documented by Gómez et al 15 , Arokyamuthu V et al 16 , Kharge et al 17 and Inglis A et al 9 in their respective studies. Coppejans HC et al 18 and Simin A et al 10 evaluated that the females in the sitting group required less ephedrine as compared to lateral group.…”

Effect on haemodynamic parameters following spinal anaesthesia in sitting versus left lateral position for lower segment caesarean section: a comparative study

“…12 Ramayyan et al found that hemodynamic stability was more in the sitting position whereas Kharge et al found no significant difference in hemodynamic parameters in the two positions but the participants seemed more comfortable in the lateral position (p< 0.001). 9,13 In this study we could not find significant difference in the time to reach sensory block level to T6 in the sitting versus left lateral positions (3.97±0.94 min; 4.05±0.90 min; p=0.57). Though one of our earlier study found the onset to be faster in the lateral position, the insignificant finding might result from adjustment in table position by the attending anaesthesiologist.…”

Comparison of the Hypotension in Lateral Verses Sitting Positions during Induction of Spinal Anaesthesia for Caesarean Section

“…The medical sympathectomy after spinal anesthesia increases gravity-induced peripheral blood pooling, which usually leads to significant hypotension. The lateral recumbent position causes less hypotension compared to the sitting position [9].…”