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OBSTETRIC ANESTHESIA

The Sitting Versus Right Lateral Position During Combined Spinal-Epidural Anesthesia for Cesarean Delivery: Block Characteristics and Severity of Hypotension

Department of Anesthesia, University Hospital Antwerp, Edegem, Belgium

Address correspondence and reprint requests to Marcel P. Vercauteren, Associate Professor, Department of Anesthesia, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium. Address e-mail to marcel.vercauteren{at}uza.be.

In the present study we evaluated whether the sitting position during initiation of small-dose combined spinal-epidural anesthesia (CSE) would induce less hypotension as compared with the lateral position. Sixty women undergoing elective cesarean delivery were randomly assigned to receive a spinal injection consisting of 6.6 mg hyperbaric bupivacaine with sufentanil 3.3 µg in either the lateral or the sitting position. After securing the epidural catheter, patients were turned to a 15° left lateral supine position. Ephedrine 5 mg IV was administered prophylactically and subsequently in case of nausea/vomiting and/or hypotension, defined as a systolic blood pressure less than 95 mm Hg or a 25% decrease from baseline values. Although the incidence of ephedrine supplementation was not different, females in the sitting group required less ephedrine (P = 0.012) and there were fewer problems with identifying the epidural space (P = 0.01). However, more patients in this group required epidural supplementation (35% versus 3%; P = 0.007). In the lateral group, blocks extended more cephalad than with the sitting position (P = 0.014). Apgar scores did not differ, but umbilical artery pH values were significantly higher in patients of the sitting group (7.31 ± 0.04 versus 7.26 ± 0.03; P = 0.02). We conclude that performing a CSE technique for cesarean delivery in the sitting position was technically easier and induced less severe hypotension.

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