Neuraxial techniques for labor analgesia should be placed in the lateral position

Tsen, Lawrence C.

doi:10.1016/j.ijoa.2007.11.005

Cited by 23 publications

(7 citation statements)

References 33 publications

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“…Several studies have indicated that the LL position is the best position for a pregnant woman on a traditional stretcher 5,8,9,15,16,17. However, prior to this study, there were no references in the medical literature to the PP on stretchers specifically designed for pregnant women.…”

Section: Discussionmentioning

confidence: 96%

Influence of the prone position on a stretcher for pregnant women on maternal and fetal hemodynamic parameters and comfort in pregnancy

Oliveira¹,

Lopes²,

Rodrigues³

et al. 2017

Clinics

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OBJECTIVES:To analyze the influence of lying in prone position on a specially designed stretcher on the maternal-fetal hemodynamic parameters and comfort of pregnant women.METHODS:A randomized, controlled trial with 33 pregnant women divided into 2 groups: pregnant group sequence 1 and pregnant group sequence 2. The order of positions used in sequence 1 was Fowler’s position, prone position, supine position, left lateral, Fowler’s position 2, supine position 2, prone position 2 and left lateral 2. The order of positions used in sequence 2 was Fowler’s position, prone position, left lateral, supine position, Fowler’s position 2, left lateral 2, prone position 2 and supine position 2. Each woman remained in each position for 6 minutes. For the statistical analyses, we used Wilcoxon’s test for 2 paired samples when comparing the prone position with the other positions. The variables are presented in graphs showing the means and 95% confidence intervals. Trial Registration: Clinical Trial No. ISRCTN41359519RESULTS:All the parameters were within the standards of normality. There were no differences between positions in terms of maternal heart rate, diastolic blood pressure, oxygen saturation and fetal heart rate. However, there were significant decreases in respiratory rate and systolic blood pressure in prone position 2 compared with left lateral 2. There was an increase in oxygen saturation in prone position compared with Fowler’s position and supine position 2 in both sequences. All the women reported feeling comfortable in the prone position.CONCLUSIONS:The prone position was considered safe and comfortable and could be advantageous for improving oxygen saturation and reducing the systolic blood pressure and respiratory rate.

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Section: Discussionmentioning

confidence: 96%

Influence of the prone position on a stretcher for pregnant women on maternal and fetal hemodynamic parameters and comfort in pregnancy

Oliveira¹,

Lopes²,

Rodrigues³

et al. 2017

Clinics

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“…17 Opponents of the sitting position also argue that vagal reflexes are more common in the sitting position, uterine perfusion is better in the lateral decubitus position, and due to a lower hydrostatic pressure, there is less likelihood of epidural vein puncture when neuraxial anesthesia is performed in the lateral position. 21 Furthermore, Patel et al 18 observed that the sitting position was associated with a higher incidence of inadequate block. However, in Patel's study, block supplementation in the sitting group was performed before assessing the maximum height of the block, thus, unnecessary supplementation could not be ruled out.…”

Section: Discussionmentioning

confidence: 99%

Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial

El-Hakeem

Kaki

Almazrooa

et al. 2011

Can J Anesth/J Can Anesth

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Background Patient position after spinal anesthesia has had variable effects on blood pressure and ephedrine requirements. The aim of this study was to determine the effects that sitting the patient up for five minutes after spinal anesthesia would have on intraoperative fluid and ephedrine requirements. Methods The study included 120 women at term gestation who were scheduled for Cesarean delivery under spinal anesthesia. After anesthetic administration, the women were randomized either to sit up for five minutes then lie down (Group S) or to lie down immediately (Group L) to a tilted supine position. A blinded observer recorded sensory block level, systolic blood pressure, heart rate, ephedrine and fluid requirements, adverse events, and time to motor recovery (modified Bromage score of 2). Results Group S had a lower intraoperative sensory block height than Group L [T4 (1) vs T2 (1), respectively; P \ 0.001]; Group S also required less ephedrine (8% vs 47%, respectively; P \ 0.001), received less fluid [709 (59) mL vs 789 (90) mL, respectively; P \ 0.001], and experienced less nausea and vomiting (5% vs 22%, respectively; P = 0.014) and shortness of breath (3% vs 28%, respectively; P \ 0.001) intraoperatively. In Group S, the odds of requiring ephedrine were 0.09 compared with 0.89 in Group L (odds ratio 0.10). There were no differences in systolic blood pressure (P = 0.127) or heart rate (P = 0.831) over time between groups. Time to a modified Bromage score of 2 was longer in Group S than in Group L [101 (15) min vs 88 (14) min, respectively; P \ 0.001]. Conclusions Sitting the patient up for five minutes rather than laying the patient down immediately after spinal anesthesia for Cesarean delivery decreased intraoperative sensory block height, ephedrine and fluid requirements, and intraoperative nausea, vomiting, and shortness of breath without affecting systolic blood pressure or the success of the anesthetic. However, the method resulted in delayed postoperative motor recovery. RésuméContexte Il a e´te´de´montre´que la position du patient a`la suite d'une rachianesthe´sie a des effets variables sur la Authorship contributions Drs. Essam E. Abd El-Hakeem, Abdullah M. Kaki, and Adnan A. Almazrooa contributed to the conception and design of the study and to acquisition of the data and its interpretation. Dr. Nisma M. Al-Mansouri made substantial contribution to the recruitment of patients, acquisition of data, and obtaining the necessary references. She helped draft the manuscript and approved its final submitted version. Dr. Jamal A. Alhashemi performed the statistical analysis and he made substantial contribution to the interpretation of the data, drafting the manuscript and revising it for important intellectual content.

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“…6 8 Further work is warranted on the effect on haemodynamics of the position preceding that which is used for surgery; however, if this bears out the supposition that the left lateral position should be taken up before final supine positioning, then it might also add support for the use of the lateral position for block insertion, during block development, or both. 14…”

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confidence: 99%

II. Lateral tilt at Caesarean section: one angle fits all or made-to-measure?

Kinsella

2012

British Journal of Anaesthesia

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Neuraxial techniques for labor analgesia should be placed in the lateral position

Cited by 23 publications

References 33 publications

Influence of the prone position on a stretcher for pregnant women on maternal and fetal hemodynamic parameters and comfort in pregnancy

Influence of the prone position on a stretcher for pregnant women on maternal and fetal hemodynamic parameters and comfort in pregnancy

Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial

II. Lateral tilt at Caesarean section: one angle fits all or made-to-measure?

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