title: Influence of lateral decubitus positioning after combined use of hyperbaric and hypobaric ropivacaine on hemodynamic characteristics in spinal anesthesia for caesarean section.
abstract: OBJECTIVE
  Positioning of the patient during and after surgery can have significant implications on recovery. Therefore, the purpose of the present study was to determine the influence of placing patients in a lateral decubitus position for 15 min after combined use of hyperbaric and hypobaric ropivacaine and assess hemodynamic characteristics during spinal anesthesia for caesarean section.
  
  
  METHODS
  One hundred-forty patients undergoing elective cesarean delivery with combined use of hyperbaric and hypobaric ropivacaine were included in the present study. Patients meeting inclusion criteria (134) were randomly allocated into Group A: immediately turned to the supine position after induction of spinal anesthesia (n = 67) or Group B: maintained in a lateral decubitus position for 15 min before being turned to the supine position (n = 67). Primary endpoints of the study were to compare hemodynamic characteristics and sensory blockade levels in the two groups, while a secondary endpoint was to observe the incidence of complications.
  
  
  RESULTS
  Both groups showed similar effects of the combined anesthetic treatment. Incidence of hypotension (43% vs 18%, P = 0.001), systolic AP < 90 mmHg (36% vs. 16%, P = 0.011), usage of ephedrine (43% vs. 18%, P = 0.001) and the total dose of ephedrine [0 (0-24) vs 0 (0-18), P = 0.001] were significantly higher in Group A compared to Group B. Group A had a higher incidence of nausea compared to Group B (25% vs 7%, P = 0.005).
  
  
  CONCLUSIONS
  Combined use of hyperbaric and hypobaric ropivacaine had satisfactory anesthetic effects and a more stable hemodynamic characteristic than either drug used alone. Maintaining the patient in a lateral decubitus position for 15 min can significantly decrease the incidence of hypotension.
authors: Department of Anesthesiology, Beijing You An Hospital, Capital Medical University Beijing 100069, China.
authors: Zhe-Feng
authors: ZF
authors: Quan
authors: Department of Anesthesiology, Beijing You An Hospital, Capital Medical University Beijing 100069, China.
authors: Hai-Li
authors: HL
authors: He
authors: Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University Beijing 100050, China.
authors: Ming
authors: M
authors: Tian
authors: Department of Anesthesiology, Beijing You An Hospital, Capital Medical University Beijing 100069, China.
authors: Ping
authors: P
authors: Chi
authors: Department of Anesthesiology, Beijing You An Hospital, Capital Medical University Beijing 100069, China.
authors: Xin
authors: X
authors: Li
keywords: Spinal anesthesia; caesarean section; hyperbaric ropivacaine; hypobaric ropivacaine; lateral decubitus position