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COMPARISON OF MODIFIED LATERAL DECUBITUS POSITION WITH TRADITIONAL POSITIONS USED FOR ADMINISTRATION OF SPINAL ANESTHESIA IN PREGNANT WOMEN FOR CESAREAN SECTION: A RANDOMISED CONTROLLED TRIAL
Abstract Number: T-28
Abstract Type: Original Research
INTRODUCTION: Spinal anesthesia is traditionally administered in the sitting or lateral decubitus position. To achieve higher success rate of spinal anesthesia in pregnant patients undergoing caesarean delivery, we tested the utility of modified 45 degree head up position in lateral decubitus position for administration of spinal anaesthesia.
METHODS: After getting institutional ethical committee clearance and written informed consent, 90 term pregnant patients with ASA status I to II undergoing caesarean section under spinal anaesthesia were enrolled in this study. Patients were randomized into three groups, sitting (Group S), lateral decubitus (Group L), modified lateral decubitus (Group H) based on the position used during the administration of spinal block. The primary outcome was first attempt success rate of lumbar puncture. Additional outcomes included were number of attempts needed, time taken for lumbar puncture, time to effective sensory and motor blockade, incidence of hypotension, block failure and patient satisfaction. The performer of the procedure had more than three years training in Anaesthesiology. All outcomes were noted down by an independent observer.
RESULTS: Demographic data were statistically comparable between the groups. First attempt success rate of lumbar puncture was significantly higher in Group H (73.33%) as compared to Group S (46.67%) and Group L (40.00%) (p value = 0.024).On inter-group comparison, significant difference was found between Group H vs. Group L (p value = 0.009).No significant difference was found in additional outcomes studied.
DISCUSSION: During pregnancy, ligamentum flavum feels less dense and softer due to hormonal changes; thus, the appreciation of passing the spinal needle may be more difficult. It is also difficult for a pregnant woman to achieve maximum flexion of lumbar spine. By doing modified 45 degree head up when the patient is placed in lateral decubitus position, there is an increase in CSF pressure, thus widening the sub arachnoid space and increasing the chance of successful lumbar puncture. Also, the patient is supported on the OT table and is less susceptible to movement during the procedure. This position has been previously studied in other patient populations to give favourable results.[1,2] The results of this study prove that modified lateral decubitus position is the best to achieve highest success rate of lumbar puncture in first attempt in full term pregnant women undergoing caesarean section without compromising the block characteristics, hemodynamic stability, failure rate and patient satisfaction.
1. Apiliogullari S et al. The effects of 45 degree head up tilt on the lumbar puncture success rate in children undergoing spinal anesthesia. Paediatr Anaesth. 2008; 18:1178–82
2. Sahin SH et al. Modified 45-degree head-up tilt increases success rate of lumbar puncture in patients undergoing spinal anesthesia. J Anesth. 2014 Aug; 28(4):544–8.