Left lateral vs. supine, wedged position for development of block after combined spinal‐epidural anaesthesia for Caesarean section

• Published in: Anaesthesia Vol. 59; no. 9; pp. 894 - 898
• Main Authors: Lewis, N. L., Ritchie, E. L., Downer, J. P., Nel, M. R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.09.2004; Blackwell
• Subjects: Adult; Anaesthesia; Anesthesia; Anesthesia, Epidural - methods; Anesthesia, Obstetrical - methods; Anesthesia, Spinal - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Apgar Score; Biological and medical sciences; Cesarean Section; combined spinal‐epidural; Female; Humans; Medical sciences; obstetric; Posture; Pregnancy; Prospective Studies; Supine Position; Time Factors; Extradural; combined spinal-epidural. Posture; Anesthesia; Anaesthesia; obstetric; Obstetrics; Posture
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/j.1365-2044.2004.03752.x

Summary This prospective, randomised controlled trial compared a spinal block developing in the left lateral position (LL), after siting a combined spinal‐epidural for Caesarean section with the woman sitting – using intrathecal hyperbaric bupivacaine and fentanyl – with a block developing in the supine, wedged position (SW). The median (IQR) block onset times for loss of cold sensation to T4 bilaterally for LL and SW women were 15 (13–19) and 12 (10.8–14) min, respectively (p = 0.004). Unilateral blocks did not occur in the left lateral group. There were no other significant differences between groups, except the median [range] 1‐min Apgar scores, which were 9 [8–10] and 9 [6–9] in the LL and SW groups, respectively (p = 0.04). In summary, the LL position is associated with a relatively slower block onset, but produces a spinal block with similar characteristics to that obtained in the SW position.