title: Improved epidural analgesia in the parturient in the 30 degree tilt position.
abstract: OBJECTIVE
  To compare the incidence of incomplete analgesia when epidural local anesthetic is administered with the parturient supine in a 30 degree leftward tilt or in the left lateral decubitus position.
  
  
  METHODS
  After placement of a multiorifice catheter 5 cm into the epidural space, 293 women in active labour were randomly positioned either to the left lateral decubitus position (lateral group) or supine with a 30 degree leftward tilt (tilt group) and then received 13 mL bupivacaine 0.25%. The success of the epidural block was determined by asking the patient if she required additional medication 15 min later. The incidence of complications (fetal heart rate decelerations, hypotension, and ephedrine usage) was noted.
  
  
  RESULTS
  In the lateral group, 38% required additional medication compared with 24% in the tilt group (P = 0.006). There were no differences between groups in the incidence of maternal hypotension or fetal heart rate decelerations, but more women (10%) received ephedrine in the lateral than in the tilt group (4%), P = 0.035.
  
  
  CONCLUSIONS
  Placing the parturient supine with a 30 degree leftward tilt is associated with a greater success rate of labour epidural analgesia without an increase in complications than in women in the left lateral decubitus position. This advantage should be considered when positioning the parturient after epidural catheter placement.
authors.affiliation: Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY 10029, USA. yaakov.beilin@mountsinai.org
authors.forename: Y
authors.initials: Y
authors.lastname: Beilin
authors.forename: S E
authors.initials: SE
authors.lastname: Abramovitz
authors.forename: J
authors.initials: J
authors.lastname: Zahn
authors.forename: S
authors.initials: S
authors.lastname: Enis
authors.forename: S
authors.initials: S
authors.lastname: Hossain
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D004809:Ephedrine / Q000627:therapeutic use; D005260:Female; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D011187:Posture / Q000502:physiology*; D011247:Pregnancy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D004809:Ephedrine