A prospective study to compare two different sitting positions for spinal anaesthesia in women undergoing elective caesarean delivery

Dr. Sarla Hooda; Dr. Shashi Kiran; Dr. Garima Vashisht

Volume : VII, Issue : XII, December - 2017

A prospective study to compare two different sitting positions for spinal anaesthesia in women undergoing elective caesarean delivery

Dr. Sarla Hooda, Dr. Shashi Kiran, Dr. Garima Vashisht

Abstract :

Background: The most common complication of spinal anaesthesia in parturients is hypotension and subsequent risk of decreased uteroplacental perfusion. During caesarean delivery maternal position is particularly important as it can affect the spread of the block resulting in variable incidence of hypotension. The aim of the study was to assess the effect of parturient’s position on quality of block during induction of spinal anaesthesia for caesarean delivery in traditional sitting and Hamstring stretch positions and their comparison with regards to differences in haemodynamic parameters, degree of hypotension, patient’s comfort and number of needle–bone contacts.

Material & Methods: One hundred twenty ASA physical status I and II parturients undergoing elective caesarean delivery were randomised to receive spinal anaesthesia in traditional sitting position (Group S) or Hamstring stretch position (Group H). Using L₃–L₄ interspace, parturients received intrathecal 1.5ml (0.5%) hyperbaric bupivacaine with 25mcg fentanyl, after which they were immediately placed in supine position. Perioperatively heart rate, changes in blood pressure (systolic, diastolic & mean), onset of sensory and motor block, ephedrine & atropine requirement were recorded. Quality of parturient’s anatomical landmarks was assessed by number of needle–bone contacts. Maternal hypotension was defined as systolic blood pressure <100mm Hg or decrease in systolic blood pressure by >30mm Hg or a fall in mean arterial pressure by >20% from baseline.

Results: Parturients in Group H experienced more fall in systolic blood pressure (Mean±SD) 113.90 ± 8.58 mmHg as compared to those in Group S (Mean±SD) 117.47 ± 10.3 mmHg for initial fifteen minutes after administration of spinal anaesthesia and this difference was statistically significant (p = 0.041). However, there was no significant fall in mean arterial pressure and diastolic blood pressure between the two groups. It was easy to administer spinal anaesthesia in traditional sitting position as compared to Hamstring stretch position. There were fewer needle–bone contacts in traditional sitting position than Hamstring stretch position and traditional sitting position was also more comfortable for the parturient.

Conclusion: Traditional sitting position offers greater haemodynamic stability in patients undergoing spinal anaesthesia for caesarean delivery and provides better patient comfort during the procedure with fewer number of needle–bone contacts.