Comparison of Maternal and Neonatal Effects of Combined Spinal Epidural Anesthesia in the Sitting or Lateral Position During Elective Cesarean Section

Abstract

Objective:Our goal was to demonstrate which position would be hemodynamically and technically better by comparing the effects of combined spinal epidural (CSE) in the sitting or lateral decubitus position for elective cesarean deliveries on maternal and neonatal parameters and ephedrine requirement.Methods: Sixty parturients were randomly assigned into two groups to perform CSE in the sitting (Group I, n=30) or right lateral decubitus position (Group II, n=30) using hyperbaric 10 mg bupivacaine and 20 µg fentanyl. Mean arterial pressure (MAP), heart rate (HR), and characteristics of sensory and motor block were recorded from intrathecal drug administration until the end of surgery. Ephedrine and 1 st analgesic requirement, number of attempts to perform CSE, incidence of paresthesia during spinal needle insertion, and Apgar scores were recorded.Results: Ephedrine requirements and HR changes were similar in both groups. However, MAP values at 45 min in Group II were significantly less than in Group I. Maximum sensory block levels in Group II were significantly higher than in Group I. Despite similar motor block recovery times in both groups, regression times of sensory block and 1st analgesic requirement in Group II were significantly longer than in Group I. Incidence of paresthesia due to spinal needle (3.3% versus 20% in Groups I and II, respectively) and number of attempts to perform CSE (26.7% versus 60% in Groups I and II, respectively) were significantly higher in Group II. Apgar scores were similar in both groups. Conclusion:Performing CSE in the sitting position would be safer and easier because higher and earlier onset of sensory block, and a greater number attempts at epidural insertion and paresthesia develop to spinal needle insertion in the right lateral position.

A Comparative Study of Effects of Sitting and Lateral Positions on Quality of Block during Induction of Spinal Anaesthesia in Patients Undergoing Cesarean Section

“…[1] Of late many anesthetists have preferred using sitting posture of giving spinal anesthesia. [2,3,4] In this study a comparison is done on all parameters of spinal anesthesia effects after giving block in sitting and lateral positions. This article aims at establishing the facts and a review of the basics related to giving a spinal anesthesia.…”

Effects of neuraxial anesthesia in sitting and lateral positions on maternal hemodynamics in cesarean section: A systematic review and meta-analysis

“…the full version of 21 were retrieved after screening and detailed selection. Finally, 803 participants from 12 studies [7][8][9][10][12][13][14][15][16][17][18][19] were included in this metaanalysis. The flow chart of study selection was shown in Fig 1.…”

“…The details of the study characteristics were shown in Table 1. Spinal anesthesia was performed in 5 studies [9,12,13,17,19], combined spinal-epidural anesthesia was performed in 7 studies [8,10,[14][15][16][17][18]. A total of 803 participants were enrolled, 415 patients from lateral position group, 388 patients from sitting group.…”

“…The quality of the included RCTs was assessed using the Revised Cochrane Risk of Bias 2.0 tool [20], The risk of bias of the included studies was shown in Fig 2 . From the Cochrane Risk of Bias assessment, 2 RCTs [9,13] were classified as having a low risk, 9 RCTs [7,8,12,[14][15][16][17][18][19]were classified as having 'some concerns', and 1study [10] was classified as having a high risk.…”

Comparison of induction of spinal anesthesia in sitting position with legs parallel and crossed for cesarean section: A randomized controlled trial

“…Sitting or lateral positions are the standard positions used in parturients for subarachnoid blocks. [ 1 2 ] The landmarks of the spine can be easily identified in sitting positions and hence preferred in obese parturients. [ 3 4 ] Sitting position will reduce the lordosis of the spine seen in pregnancy and make spinal puncture easier.…”