Role of patient posture during puncture on successful unilateral spinal anaesthesia in outpatient lower abdominal surgery.
OBJECTIVE
Unilateral spinal anaesthesia is a useful anaesthesia technique in lower abdominal surgery, especially in an outpatient setting. Patient posture is pivotal in the achievement of unilateral anaesthesia. Nevertheless, no studies have elucidated the influence of patient posture during the anaesthetic injection on unilaterality. Thus, the aim was to compare the effect of patient posture, during the induction phase of spinal anaesthesia, on block characteristics.


METHODS
Eighty patients, ASA I-II, scheduled for unilateral hernioplasty were randomized into two groups. Anaesthesia was performed in lateral position in Group 1 (G1) with operative side down and in sitting position in Group 2 (G2) whose patients were then immediately turned on their lateral side. All patients were maintained for 20 min in lateral position with their operative side down. Hyperbaric bupivacaine 1% 10 mg were used.


RESULTS
Unilateral anaesthesia was seen in 80% (32/40) and 12.5% (5/40) of G1 and G2, respectively. The readiness for surgery was faster in G1 (P < 0.0001). The motor block in the non-operative side was stronger in G2 (P < 0.0001). The offset of sensory block was faster in G1 (P = 0.0001). The offset of motor block was slower in G1 (P = 0.0008). The time for voiding was shorter in G1, although not significant.


CONCLUSIONS
Lateral posture during the induction of spinal anaesthesia is pivotal for a higher success of unilateral block, a fast readiness to surgery, and a fast recovery. Therefore, this technique can be considered feasible and time-saving for lower abdominal surgery.
Al Malyan
M
M
Department of Medical and Surgical Critical Care, Section of Anaesthesia and Intensive Care, Florence University, Italy.
Becchi
C
C
Falsini
S
S
Lorenzi
P
P
Boddi
V
V
Marsili
M
M
Boncinelli
S
S
D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000762:Anesthesia Recovery Period; D000775:Anesthesia, Spinal / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D011187:Posture / Q000502:physiology; D011677:Punctures / Q000379:methods*; D013997:Time Factors
D018686:Anesthetics, Intravenous; D008874:Midazolam