Comparison Between Pendant Position and Traditional Sitting Position for Successful Spinal Puncture in Spinal Anesthesia for Cesarean Section

Abstract

BackgroundSuccess of spinal anesthesia in pregnant females is strongly influenced by the position of the patient at the time of spinal insertion. Pendant position is a new position introduced to increase the intervertebral spaces. The current study aimed at comparing successful spinal puncture among the patients with pendant position in comparison with the ones with traditional sitting position for the elective caesarean section.MethodsThe current study was a non-blinded, randomized controlled trial (RCT) (registration code: NCT02753660 (ClinicalTrial.gov) on pregnant females undergoing spinal anesthesia. The participants were divided into 2 groups by the random consecutive sampling method; group A (pendant position) and group B (traditional sitting position). The successful placement of spinal needle was determined by the number of attempts, the amount of bone contact, and the time of spinal puncture. The inclusion criteria were pregnant females aged 18 to 45 years, body mass index (BMI) of 18 to 35 kg/m2, and the physical status I to III, based on American society of anesthesiologists classification (ASA).ResultsFollowing the approval of the ethical committee, 308 subjects were enrolled in the study. The rate of successful puncture on the 1st attempt of group A was significantly high (92% vs. 78%, P value = 0.001). Additionally, group A had significantly less total amount of bone contact (185 vs. 421, P value < 0.001) and shorter time for spinal puncture (9 seconds vs. 12 seconds, P value < 0.001).ConclusionsPendant position was significantly better than traditional sitting position to provide successful 1st attempt spinal puncture in pregnant females undergoing cesarean section.

Postoperative resveratrol administration improves prognosis of rat orthotopic glioblastomas

“…This phenomenon indicated the general anaesthesia used at each LP resveratrol administration may affect rat health and shorten their life span. In clinical practice, local anaesthesia is used for lumbar puncture [ 33 ]. Therefore, the adverse effects of repeated general anaesthesia on rat health do not apply to the patients.…”

Comparison of Successful Spinal Needle Placement Between Crossed-Leg Sitting Position and Traditional Sitting Position in Patients Undergoing Urology Surgery

“…Pryambodho et al (14) compared spinal needle placement success rates between the pendant position and the TSP in 2014, and they found that the pendant position had a higher success rate of spinal needle placement. Pendant position is a sitting position with the patient’s underarms propped up by a cantilever.…”

“…The spinal anesthesia operator then has direct access to the median area of the vertebrae without being restricted by the upper part of the bed. This position is the most commonly used variant of the sitting position (12-14). The problem with this position is the need for a chair to prop up the patient’s feet and the need for two assistants to help move the patient’s feet to a supine position.…”

Comparison of successful spinal puncture between pendant position and traditional sitting position for cesarean deliveries

“…Poor positioning can result into multiple needle pricks and needle-to-bone contacts, thus increasing risk of backache, epidural hematoma, neural trauma and post-dural puncture headache (PDPH). [5][6][7][8] Lumbar spine curvature increases significantly in the last trimester of pregnancy, shifting center of gravity towards abdomen causing lumbar hyperlordosis. 9 Hyperlordosis produces vertebral space narrowing; while lumbar flexion is difficult to achieve in pregnant patients making median approach for spinal puncture very difficult.…”

“…9 Hyperlordosis produces vertebral space narrowing; while lumbar flexion is difficult to achieve in pregnant patients making median approach for spinal puncture very difficult. 8 Sitting position has several modifications, i.e. traditional sitting position (TSP), pendant position, squatting position (SP), hamstring stretch position (HSP) and crossed-leg sitting position (CLSP).…”