Comparison of Severity of Hypotension between Different Positions during Spinal Anaesthesia for Elective Caesarean Section

Abstract

BACKGROUNDElective caesarean section can be performed via the spinal, epidural or the combined spinal-epidural route. Although each of these techniques come with their own pros and cons, a single shot spinal anaesthesia is the preferred and most widely accepted technique with reliable and predictable degree of anaesthesia. Though, a subarachnoid block is easy to perform, it is associated with a greater extent of hypotension, which, if severe enough can have a telling effect on both the mother and the neonate. The purpose of this study was to investigate, if the maternal position while administering spinal anaesthesia can play a role in minimizing the extent of hypotension. Subsequent requirement of vasopressor (Phenylephrine) was also noted. METHODSThis was a prospective study and was carried out at R.G. Kar Medical College, Kolkata, over a period of 1 year. 150 ASA 2 patients aged 18 years and above, undergoing elective caesarean section, were divided into 5 groups. Women in each group were placed in a particular position for administering spinal anaesthesia with 12.5 mg of intrathecal 0.5% hyperbaric bupivacaine. Noninvasive blood pressure, heart rate and vasopressor requirement were measured at intervals of 5 minutes for a period of 15 minutes, for women in each group. RESULTSIt was observed that women who were kept in the sitting position for 5 minutes after administration of spinal anaesthesia and gradually placed in the supine position (Group 5) experienced the least incidence of hypotension and changes in heart rate. Consequently, the requirement of vasopressor (Phenylephrine) was also low in them compared to the other groups. CONCLUSIONSThe study showed that the extent of hypotension following spinal anaesthesia can be minimized by altering the position of the parturients.