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

Abstract

BackgroundThe patient’s position during spinal anesthesia administration plays a major role in the success of spinal needle insertion into the subarachnoid space. The traditional sitting position (TSP) is the standard position for spinal anesthesia administration, but the success rate for spinal anesthesia administration in the TSP is still quite low. The crossed-leg sitting position (CLSP) is one of the alternative positions for the administration of spinal anesthesia, which can increase the degree of lumbar flexion.ObjectivesThis study aimed to compare successful spinal needle placement to patients in the CLSP and patients in the TSP prior to undergoing urology surgery.MethodsThis study was a non-blinded, randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures from March-October, 2015 in the central national hospital Dr. Cipto Mangunkusumo, Indonesia. After obtaining approval from the FMUI – RSCM (Faculty of Medicine Universitas Indonesia – Rumah Sakit Dr. Cipto Mangunkusumo) Ethical Committee and informed consent from patients, 211 subjects were allocated into two groups: the CLSP group (n = 105) and the TSP group (n = 106). The proportion of successful spinal needle placement to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contacts in both groups were then assessed and analyzed.ResultsThe rate of first-time successful spinal needle insertion was not significantly different between the CLSP and TSP groups (62.9% versus 55.7%, P > 0.05). Ease of landmark palpation in the CLSP group was not significantly different from that in the TSP group (86.7% versus 76.4%, P > 0.05). The number of needle-bone contacts in both groups were not significantly different (P > 0.05). The complication rates were similar in both groups.ConclusionsThe rate of successful spinal needle placement in the CLSP group was not significantly different from that in the TSP group in patients undergoing urology surgery. The CLSP can be used as an alternative sitting position for administration of spinal anesthesia.

Comparing Three Different Modified Sitting Positions for Ease of Spinal Needle Insertion in Patients Undergoing Spinal Anesthesia

“…The number of spinal needle-bone contacts was lower in the SP group, nonetheless ease of needle insertion or space identification was the same in both groups ( 4 ). Manggala et al, compared the Crossed-Leg Sitting Position (CLSP) with TSP in patients undergoing urologic surgery and concluded that there was no significant difference in success rate of needle placement between the 2 groups and they suggested that the CLSP can be used as an alternative sitting position for administration of spinal anesthesia ( 5 ).…”

The ‘Cross-Legged Foetal Sitting Neuraxial Position’: Is it Beneficial?-A Prospective Randomised Clinical Trial Via Ultrasonography

“…Only one study compared the success of spinal needle placement between the crossed-leg sitting position (CLSP) and the TSP. In their research, Manggala et al ( 15 ) kept the patients in the CLSP by hugging a pillow. They used neither an imaging technique nor a patient comfort score.…”

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.…”

“…Each position has its own advantages. 5 TSP is the most commonly used position by the anesthetist, providing uninterrupted access to median area of vertebrae without being restricted by upper part of the table. 5 In pendant position propped underarms reduce vertical pressure (gravity) on the vertebrae, thus increasing intervertebral and inter-spinous distance and interlamina gap.…”

“…5 TSP is the most commonly used position by the anesthetist, providing uninterrupted access to median area of vertebrae without being restricted by upper part of the table. 5 In pendant position propped underarms reduce vertical pressure (gravity) on the vertebrae, thus increasing intervertebral and inter-spinous distance and interlamina gap. 5,10 A study by Pryambodho et al compared pendant position with TSP in Indonesian population for cesarean section; they concluded that pendant position is much better for achieving spinal puncture in first attempt (p = 0.0007), number of needle-to-bone contact (p = 0.0005) and less time for successful spinal (9 sec vs. 12 sec, p = 0.001).…”