BackgroundThe most important point for performing a neuroaxial block in a sitting position is reducing lumbar lordosis, resulting in easier access to interspinous space and dura mater. There are a few studies comparing 2 different sitting positions including a traditional sitting position (TSP) versus forward bending or hamstring stretch position (HSP) as well as TSP versus squatting position (SP) for reversing the lumbar lordosis and improving access to intervertebral space for neuroaxial block.ObjectivesWe compared 3 different sitting positions including traditional sitting position vs. hamstring stretch position vs. squatting position and hypothesized that squatting position reverses the lumbar lordosis and reduces the number of spinal needle bone contacts more than TSP and HSP.MethodsA total of Thirty hundred and sixty ASA class I or II patients aged 18 to 60 years were scheduled for elective surgeries under spinal anesthesia were randomized into 3 groups. Our primary endpoint was the number of spinal needle-bone contacts and our secondary endpoint was ease of needle insertion or space identification.ResultsDemographic data were statistically different between the study groups. There was no statistical difference between the study groups regarding the number of needle bone contacts and the ease of finding intervertebral space (P = 0.63, P = 0.56, respectively).ConclusionsThere was no statistical difference between the TSP, HSP, and SP regarding the number of needle bone contacts and the ease of finding of intervertebral space. In this regard, each of these 3 positions can be used as an alternative sitting position for administration of spinal anesthesia.

Background Lumbosacral radicular pain (LRP) is usually caused by herniation of intervertebral discs and is characterized by pain arising in the back and radiating to the lower extremities. The current study evaluated the efficacy of gray ramus communicans nerve block (GRCNB) in decreasing LRP in patients with intervertebral disc herniation who underwent transforaminal epidural block. Method Thirty patients with magnetic resonance imaging indicating a disc herniation on the L4-L5 level participated in this study. All patients were randomly divided into two groups: one whose members underwent GRCNB (n = 15) after transforaminal epidural block, and a second group (n = 15) whose members underwent only transforaminal epidural block on L4-L5 on the affected side. Follow-up after the procedure ran for a period ranging from 6 to 10 months (mean = 8.2 ± 2.1 months) for radicular pain score and the need for analgesics. Results Mean age of the patients was 54.8 ± 18.4 years (range: 30–65 years). LRP duration in all patients before the procedure was 6–24 months (mean: 12 ± 10.9 months), and there was no significant difference between the two groups. A greater reduction in the numerical rating scale (NRS) one week, 1, and 6 months after the procedure was observed in the group with GRCNB compared to the other group. The reduction in need for analgesics one week, 1, and 6 months after the procedure was statistically significant in the group with GRCNB compared to the group without GRCNB. No major complications were observed in any of the patients in either group. Conclusion GRCNB is effective in reducing radicular pain and the need for analgesics in patients with lumbosacral radicular pain.