Abstract
Aims and Objective: The aim of the study was to compare the characteristics of sensory blockade, intraoperative hemodynamic changes and the need for vasopressors when spinal anaesthesia was induced in the left lateral decubitus position and sitting position in Elective Lower Segment Caesarean Section cases in hospital setting.
Methods: 64 parturient of ASA I /II at full term gestation and presenting for Elective Lower Segment Caesarean Section surgery were enrolled and allocated to either of two groups, Group 1:(( Parturient in sitting position during induction of spinal anaesthesia (n=32)) and Group 2(: Parturient in left lateral decubitus position during induction of spinal anaesthesia (n=32)) using computer generated random numbers in this prospective randomised double blind study.2ml of 0.5% hyperbaric bupivacaine was injected into intrathecal space while the patients were in sitting or left lateral decubitus position at L3-L4 level. Sensory block characteristics and hemodynamic parameters were recorded and analysed.
Result: Demographic profile were comparable in both groups. No statistical significant differences were observed between the two study groups in sensory block characteristics and haemodynamic parameters during entire observation period during induction of spinal anaesthesia.
Conclusion: The study concludes that spinal anaesthesia with 2mL of 0.5% hyperbaric bupivacaine in both sitting position and left lateral decubitus position provides effective anaesthesia for Lower Segment Caesarean Section ensuring good hemodynamic stability and comparable sensory block characteristics.
References
- Pernoll ML, Mandell JE. Caesarean section. Chapter 30, Principles and Practice of Obstetric Analgesia and Anaesthesia, 2nd Edn.,Bonica JJ and McDonald JS, Williams and Wilkins, 1995:968-1009.
- Dresner MR, Freeman JM. Anaesthesia for caesarean section. Best Pract Res Clin Obstet Gynaecol. 2001 Feb;15(1):127-43.
- Ganeshanavar A, AmbiUday S, ShettarAdarsh E, Koppal Ramesh, R.Ravi. Comparison of Bolus Phenylephrine, Ephedrine and Mephenterminefor maintenance of arterial pressure during spinal anaesthesia in Caesarean Section . J ClinDiagn Res. 2011 Oct;5(5):948-952.
- Clyburn P. Spinal anaesthesia for caesarean section: time for re-appraisal? (Editorial). Anaesthesia. 2005;60(7):633-635.
- Hocking G, Wildsmith J. Intrathecaldrug spread. Br J Anaesth. 2004 Oct;93(4):568-78.
- Yentis S. Height of confusion: assessing regional blocks before caesarean section. Int J ObstetAnesth. 2006;15(1):2-6.
- Rucklidge MW, Paech MJ, Yentis SM. A comparison of the lateral, Oxford and sitting positions for performing combined spinal-epidural anaesthesia for elective Caesarean section. Anaesthesia. 2005;60 (6):535-40.
- Himanshu S, Bharti T, Saxena KN. Does the maternal position at the time of administration of subarachnoid block with plain Ropivacaine affect the hemodynamics? A comparative evaluation of the sitting versus lateral position. Int J Med Health Sci. 2017 Oct;6(4):237.
- Inglis A, Daniel M, McGrady E. Maternal position during induction of spinal anaesthesia for Caesarean section. Anaesthesia. 1995;50(4):363-5.
- Simin A, Naghipour B, Farzin H, Saeede M, Pouya H, Hojjat P. Effect of Position during Induction of Spinal Anaesthesia for Caesarean Section on Maternal Haemodynamic: Randomised Clinical Trial. J Clin Diagn Res. 2018 Feb;12(2): UC05-UC08.
- Tan ED, Gunaydin B. Comparison of Maternal and Neonatal Effects of Combined Spinal Epidural Anesthesia in either the Sitting or Lateral Position During Elective Cesarean Section. Turk J Anesthesiol Reanim. 2014 Feb;42(1):23-32.
- Sreekanth R., Totawar SR. Comparison of the effects of lateral and sitting position during induction of spinal anaesthesia with plain levobupivacaine in caesarean section. Ind J ClinAnaesth. 2018;5(1):86-91.
- Shahzad K, Afshan G. Induction position for spinal anaesthesia: Sitting versus lateral position. J Pak Med Assoc.2013 Jan;63(1):11-5 .
- Obasuyi BI, Fyneface-Ogan S, Mato CN. A comparison of the haemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for caesarean section. Int J ObstetAnesth. 2013;22(2):124-8.
- Ortiz-Gómez JR , Palacio-Abizanda FJ , Morillas-Ramirez F, Fornet-Ruiz I, Lorenzo-Jiménez AM, Bermejo-Albares ML. Effect of position on maternal haemodynamics during elective caesarean delivery under spinal anaesthesia. Anestezjologia i Ratownictwo. 2015;9:22-9.
- Arokyamuthu V, Joseph EJ. A Comparison of the Hemodynamic Effects of Lateral And Sitting Positions During Induction of Spinal Anaesthesia For Caesarean Section. Glob J Res Anal. 2016 April;5(4) • ISSN No 2277 – 8160
- Kharge N, Mali A, Gujjar P. Comparison of haemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for elective caesarean section. Int J Res Med Sci.2017 Feb;5(3):851-856.
- Coppejans H, Hendrickx E, Goossens J, Vercauteren M. The Sitting Versus Right Lateral Position During Combined Spinal-Epidural Anesthesia for Cesarean Delivery: Block Characteristics and Severity of Hypotension. AnesthAnalg. 2006 Jan;102(1):243-7.
Corresponding Author
Dr Pallavi Mutreja
PG Resident, Dept. of Anaesthesia, JLNHRC, Bhilai, Chhattisgarh