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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2012 June;78(6):646-52
Influence of a prolonged lateral position on induction of spinal anesthesia for cesarean delivery: a randomized controlled trial
Hwang J. W. 1, Oh A. Y. 1, Song I. A 1., Na H. S. 1, Ryu J. H. 1, Park H. P. 2, Jeon Y. T. 1, Do S. H. 1 ✉
1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea;
2 Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
BACKGROUND: Maternal hypotension occurs commonly during cesarean delivery under spinal anesthesia. We evaluated whether hypotension due to aortocaval compression could be prevented by maintaining a lateral position after an intrathecal injection.
METHODS: Eighty-six women undergoing elective cesarean delivery were enrolled. Spinal anesthesia was conducted in the right lateral position using 8 mg of hyperbaric bupivacaine and 15 µg of fentanyl. Patients were randomly assigned to maintain the right lateral position for 6 min before assuming the wedged supine position (group L), or to assume the wedged supine position immediately after the spinal injection (group S). Hypotension was defined as a decrease in mean arterial pressure to <80% of baseline. Ephedrine was given if blood pressure decreased to <70% of baseline. The incidence of hypotension and nausea, ephedrine requirement, maximal block height, and neonatal outcomes were evaluated.
RESULTS: No significant between-group differences were observed in the lowest blood pressure, total ephedrine dose, or incidence of hypotension or nausea. Onset of hypotension was delayed (6±2 vs. 10±3 min, P<0.001), and the sensory block level was more cephalad in group L than in group S (T2 [C8-T5] vs. T4 [T1-T6], P=0.001). Apgar scores did not differ between the groups.
CONCLUSION: During spinal anesthesia for elective cesarean delivery, maintaining the lateral position for 6 min after an intrathecal injection of hyperbaric bupivacaine resulted in a more gradual and higher cephalad sensory block, without an increase in the incidence of maternal hypotension.