Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial

Abstract

Background Patient position after spinal anesthesia has had variable effects on blood pressure and ephedrine requirements. The aim of this study was to determine the effects that sitting the patient up for five minutes after spinal anesthesia would have on intraoperative fluid and ephedrine requirements. Methods The study included 120 women at term gestation who were scheduled for Cesarean delivery under spinal anesthesia. After anesthetic administration, the women were randomized either to sit up for five minutes then lie down (Group S) or to lie down immediately (Group L) to a tilted supine position. A blinded observer recorded sensory block level, systolic blood pressure, heart rate, ephedrine and fluid requirements, adverse events, and time to motor recovery (modified Bromage score of 2). Results Group S had a lower intraoperative sensory block height than Group L [T4 (1) vs T2 (1), respectively; P \ 0.001]; Group S also required less ephedrine (8% vs 47%, respectively; P \ 0.001), received less fluid [709 (59) mL vs 789 (90) mL, respectively; P \ 0.001], and experienced less nausea and vomiting (5% vs 22%, respectively; P = 0.014) and shortness of breath (3% vs 28%, respectively; P \ 0.001) intraoperatively. In Group S, the odds of requiring ephedrine were 0.09 compared with 0.89 in Group L (odds ratio 0.10). There were no differences in systolic blood pressure (P = 0.127) or heart rate (P = 0.831) over time between groups. Time to a modified Bromage score of 2 was longer in Group S than in Group L [101 (15) min vs 88 (14) min, respectively; P \ 0.001]. Conclusions Sitting the patient up for five minutes rather than laying the patient down immediately after spinal anesthesia for Cesarean delivery decreased intraoperative sensory block height, ephedrine and fluid requirements, and intraoperative nausea, vomiting, and shortness of breath without affecting systolic blood pressure or the success of the anesthetic. However, the method resulted in delayed postoperative motor recovery. RésuméContexte Il a e´te´de´montre´que la position du patient a`la suite d'une rachianesthe´sie a des effets variables sur la Authorship contributions Drs. Essam E. Abd El-Hakeem, Abdullah M. Kaki, and Adnan A. Almazrooa contributed to the conception and design of the study and to acquisition of the data and its interpretation. Dr. Nisma M. Al-Mansouri made substantial contribution to the recruitment of patients, acquisition of data, and obtaining the necessary references. She helped draft the manuscript and approved its final submitted version. Dr. Jamal A. Alhashemi performed the statistical analysis and he made substantial contribution to the interpretation of the data, drafting the manuscript and revising it for important intellectual content.

How Long Can Patients Sit Up for Before Lying Down after Combined Spinal-Epidural Anesthesia For Cesarean Delivery? A Randomized Trial

“…Except for the latter, none of these factors were altered in the current study, and hence, the observation that prolonged sitting progressively limited the sensory height of the subarachnoid block was attributed solely to the length of time spent in the sitting position. These findings are in keeping with those reported by others [6,10,11]. However, this is the first study that demonstrated that patients can set up for up to 7 min without compromising the success of the spinal anaesthetic.…”

“…Several factors have been shown to affect the cephalad local anaesthetics when injected into the subarachnoid space including lumbosacral cerebrospinal fluid volume [9], local anaesthetic dose [3] and baricity [7], and patient position [3,6,10,11]. Except for the latter, none of these factors were altered in the current study, and hence, the observation that prolonged sitting progressively limited the sensory height of the subarachnoid block was attributed solely to the length of time spent in the sitting position.…”

“…Among the non-pharmacological interventions studied to minimize the incidence of hypotension, our group and others have demonstrated that sitting patients up for 5 minutes (min) following the administration of spinal anaesthesia decreases both block height and the requirement for intravenous ephedrine without affecting the success and quality of anaesthesia [6,7]. However, it is not known if prolonged sitting for more than 5 min would further limit block height and decrease intravenous ephedrine requirement, and if it would compromise the success of the spinal anaesthetic.…”

“…Hypotension [2], however, continues to be a challenging adverse effect of this anaesthetic technique despite routine left uterine displacement and efforts to limit the spread of local anaesthetic by reducing its dose [3,4] or changing the patient's position [5,6].…”

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

“…The level of sensory block was significantly higher in group H compared to group L, which was accomplished with the use of the same dose of hyperbaric bupivacaine (12,5mg) in both groups. The difference in the level of sensory block was achieved by the tilt of the operating table with a slight anti-Trendelenburg position in group L. It was shown before that with the positioning of the patient, different levels of sensory block could be achieved (36)(37)(38). We decided for the dose of hyperbaric bupivacaine that is high enough to produce high spinal block (12,5mg), even in young patients.…”