Which position is more comfortable for the parturient during identification of the epidural space?
The purpose of this study was to determine which of the two positions used by anesthesiologists to identify the epidural space is more comfortable for pregnant patients. We evaluated both the lateral decubitus position and the sitting position in 90 term parturients who were either not in labor or were in early labor (<or= 4 cm cervical dilation). Exclusion criteria included: (1) oxytocin administration; (2) opioid administration within 12 h; (3) multiple gestation; and (4) previous history of cesarean delivery. Patients were positioned in the left lateral decubitus and sitting positions for 60 s each to achieve maximal flexion of the lumbar spine. Patients were questioned as to which position they felt would be more comfortable during the time necessary to identify the epidural space and place an epidural catheter. Among all patients neither position was clearly superior with regard to patient comfort. However, patients who preferred the left lateral decubitus position weighed less (Wt 78 +/- 2 kg vs 87 +/- 3 kg, P = 0.012) and had lower body mass indices (Wt[kg]/Ht[M]2) (27.4 +/- 0.9 vs 31.3 +/- 1.0, P = 0.006) than patients who preferred the sitting position.
Vincent
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RD
Department of Anesthesia, University of Iowa College of Medicine, Iowa City 52242, USA.
Chestnut
D H
DH