title: Haemodynamic changes induced by hyperbaric bupivacaine during lateral decubitus or supine spinal anaesthesia.
abstract: OBJECTIVE
  Hypotension, the commonest side-effect of spinal anaesthesia, results from sympathetic denervation. This study compared patient positioning (supine vs. decubitus) on haemodynamic variables during spinal anaesthesia.
  
  
  METHODS
  After intravenous crystalloid preloading with 5 mL kg(-1), hyperbaric bupivacaine 0.5% 2.5 mL was injected intrathecally at the L2-3 or L3-4 interspace. Patients were then randomly assigned to be positioned immediately supine and horizontal for 30 min (Group SUP, n = 12), or remained in the lateral decubitus position (fractured hip dependent) for 30 min (Group LAT, n = 14). Systolic blood pressure, mean arterial pressure, and loss of sensation of pinprick sensation were recorded prior to induction of spinal anaesthesia (baseline) and at 1, 2, 3, 5, 10, 15, 30, 45, 60, 90 and 120 min after intrathecal injection.
  
  
  RESULTS
  In Group SUP, the percent maximum systolic blood pressure (36 +/- 13%) and percent maximum mean arterial pressure decreases (27 +/- 13%) were significantly greater (P < 0.05) than in Group LAT (30 +/- 8% and 23 +/- 11%, respectively). Additionally, there was a borderline significant delay in the time to maximum systolic blood pressure decrease in Group LAT (38 +/- 30 min) when compared with Group SUP (20 +/- 17 min, P = 0.06), while the total dose of ephedrine required in the SUP group (30 mg) was greater than that required in the LAT group (15 mg, P = 0.05). In Group LAT patients, the mean level of denervation on the operative side extended 2 dermatomes more cephalad than in Group SUP.
  
  
  CONCLUSIONS
  Lateral positioning for spinal anaesthesia delays the onset of hypotension, while requiring smaller total doses of vasoconstrictors for blood pressure maintenance.
authors.affiliation: St. Vincent's University Hospital, Department of Anaesthesia, Dublin, Ireland.
authors.forename: J D
authors.initials: JD
authors.lastname: Kelly
authors.forename: D
authors.initials: D
authors.lastname: McCoy
authors.forename: S H
authors.initials: SH
authors.lastname: Rosenbaum
authors.forename: S J
authors.initials: SJ
authors.lastname: Brull
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D002045:Bupivacaine / Q000008:administration & dosage*; D004809:Ephedrine / Q000008:administration & dosage; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery; D006801:Humans; D007022:Hypotension / Q000517:prevention & control; D007278:Injections, Spinal; D008297:Male; D009407:Nerve Block; D011187:Posture / Q000502:physiology*; D012677:Sensation / Q000187:drug effects; D016683:Supine Position / Q000502:physiology*; D013566:Sympathomimetics / Q000008:administration & dosage; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D000779:Anesthetics, Local; D013566:Sympathomimetics; D014662:Vasoconstrictor Agents; D004809:Ephedrine; D002045:Bupivacaine