Left lateral vs. supine, wedged position for development of block after combined spinal-epidural anaesthesia for Caesarean section.
This prospective, randomised controlled trial compared a spinal block developing in the left lateral position (LL), after sitting a combined spinal-epidural for Caesarean section with the woman sitting -- using intrathecal hyperbaric bupivacaine and fentanyl -- with a block developing in the supine, wedged position (SW). The median (IQR) block onset times for loss of cold sensation to T4 bilaterally for LL and SW women were 15 (13-19) and 12 (10.8-14) min, respectively (p = 0.004). Unilateral blocks did not occur in the left lateral group. There were no other significant differences between groups, except the median [range] 1-min Apgar scores, which were 9 [8-10] and 9 [6-9] in the LL and SW groups, respectively (p = 0.04). In summary, the LL position is associated with a relatively slower block onset, but produces a spinal block with similar characteristics to that obtained in the SW position.
Lewis
N L
NL
Department of Anaesthesia, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex UB8 3NN, UK.
Ritchie
E L
EL
Downer
J P
JP
Nel
M R
MR
D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D001034:Apgar Score; D002585:Cesarean Section; D005260:Female; D006801:Humans; D011187:Posture; D011247:Pregnancy; D011446:Prospective Studies; D016683:Supine Position; D013997:Time Factors