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OBSTETRIC ANESTHESIA

The Effect of Right Versus Left Lateral Decubitus Positions on Induction of Spinal Anesthesia for Cesarean Delivery

Alice C. S. Law, MB ChB^*, Kwok K. Lam, MB ChB, FANZCA, FHKAM, and Michael G. Irwin, MB ChB, FRCA, FHKAM

From the *Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, the Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong, and the Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong

Address correspondence and reprint requests to Dr. K. K. Lam, Consultant, Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong. Address email to plam{at}cuhk.edu.hk

Induction of spinal anesthesia for cesarean delivery in the left lateral (LL) decubitus position combined with intraoperative left uterine displacement may result in pooling of local anesthetic onto one side of the body. We studied the effect of the right lateral (RL) and LL decubitus positions during placement of spinal anesthesia on the intrathecal spread of 0.5% hyperbaric bupivacaine plus fentanyl in 60 term parturients. Though all parturients acquired a loss of cold sensation at T4 15 min after intrathecal injection, more parturients in the LL group than in the RL group did so at 5 min (P < 0.05). The maximum levels of sensory blockades, amounts of fluid, vasopressor, and supplementary analgesia used, and the incidence of postoperative complications were similar. We conclude that the two positions can be used equally well when hyperbaric bupivacaine and fentanyl are used in cesarean delivery under spinal anesthesia.

IMPLICATIONS: We conducted a double-blinded randomized trial comparing the spread of spinal anesthesia placed with a parturient in either the right or left lateral position. There was a faster onset in the left lateral group; however, the maximum block heights and the time taken to achieve them were similar in both groups.

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