Anesth Pain Med.  2016 Oct;11(4):354-358. 10.17085/apm.2016.11.4.354.

Effect of prolonged lateral position for 10-minutes following spinal anesthesia on hypotension and sensory blockade during cesarean delivery

• Sohn HM
• Won DW
• Oh AY
• Hwang JW
• Song IA

• KMID: 2358330
• DOI: http://doi.org/10.17085/apm.2016.11.4.354

Abstract

BACKGROUND
During cesarean delivery, hypotension is a frequently occurring adverse effect following spinal anesthesia. Our hypothesis was that hypotension could be avoided or delayed with a lateral decubitus position for 10 minutes after intrathecal injection, by reducing the detrimental effects of the aortocaval compression.
METHODS
Spinal anesthesia was performed in the lateral decubitus position with 8 mg of 0.5% hyperbaric bupivacaine and 15 µg of fentanyl. Forty-one patients undergoing elective cesarean delivery were randomly assigned to one of two groups. In the experimental group, patients were maintained in the lateral position for 10 minutes following intrathecal injection (group Decubitus). In the control group, patients were repositioned to supine immediately after the injection (group Supine). Incidence of hypotension, the required dose of ephedrine, and characteristics of the sensory blockade, were subsequently investigated.
RESULTS
The incidence of hypotension, the incidence of nausea, and total amount of ephedrine, were not statistically different between the two groups. In group Decubitus, the onset of hypotension was delayed significantly (5.6 ± 1.7 min vs. 13.8 ± 1.7 min, P < 0.001), and the maximal blockade level was more cephalad (T3 [T1-T4] vs. T4 [T3-T5], P < 0.001) when compared to that of group Supine. Apgar scores were comparable in both groups.
CONCLUSIONS
Maintaining the lateral position for 10 min following intrathecal injection during cesarean delivery did not influence the incidence of maternal hypotension. However, it caused delayed onset of hypotension and higher cephalad spread of sensory block.

Keyword

Cesarean delivery; Hypotension; Lateral decubitus; Spinal anesthesia

MeSH Terms

Anesthesia, Spinal*
Bupivacaine
Ephedrine
Fentanyl
Humans
Hypotension*
Incidence
Injections, Spinal
Nausea
Bupivacaine
Ephedrine
Fentanyl

Figure

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  Fig. 1 Consort diagram.

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