The Effect of Spinal Anesthesia that is Performed in Sitting or Right Lateral Position on Post-Spinal Headache and Intraocular Pressure During Elective Cesarean Section

Abstract

Background: Although spinal anesthesia can be applied in different patient positions, the most frequently used positions are sitting and lateral positions. It is known that different patient positions during spinal anesthesia have effects on hemodynamic parameters, postdural puncture headache, and intraocular pressure. Aim: The study aimed to determine the effect of spinal anesthesia performed in either sitting or right lateral position on postspinal headache and intraocular pressure during elective cesarean section. Patients and Methods: The study was a randomized controlled study of 104 eligible pregnant women scheduled to undergo elective cesarean section. The women were randomized into two groups. Spinal anesthesia was performed either in the sitting (Group S, n = 53) or the right lateral position (Group L, n = 51). Heart rate and blood pressure were recorded throughout the operation. The participants were informed and monitored for postspinal headaches. Intraocular pressure before and after the operation was measured with Icare PRO. The obtained data were statistically compared between the two groups. Results: There was no difference between the groups in terms of demographic data. Postdural puncture headache was observed in five patients in Group S and one patient in Group L (P =0.04). There was no difference between the groups in terms of intraocular pressure (P >.05). Heart rate was not significantly different between the groups; however, there was a significant difference in average blood pressure in 1, 5, 30, and 40 minutes (P <.05). The number of trials administered to patients for spinal anesthesia was significantly higher in Group L (P =0.01). Conclusion: Spinal anesthesia performed in the sitting position for cesarean section caused a higher postspinal headache than in the right lateral position, but the position did not affect intraocular pressure.

Effect of Patient Position during Spinal Anesthesia on the Incidence of Post-Dural Puncture Headache after Cesarean Section

“…They asserted that in sitting position group, 9.8% (5 women) and in lateral position group, only 1.9% (1 woman) had post dural puncture headache. 22 Our study further disclosed that among 20 women of sitting position group who had PDPH, 6.7% (4 women), 10.0% (6 women), 8.3% (5 women), 5.0% (3 women) and 3.3% (2 women) had day of onset 1, 2, 3, 4 and 5, respectively. However, among 4 women of lateral position group who had PDPH, 5.0% (3 women) had day of onset 1 and only 1.7% (1 woman) had day of onset 4.…”

“…Our findings are supported by a number of studies which showed a statistically significant and lower incidence of PDPH in lateral position as compared to sitting position. 2,6,21,22 The results of a similar study performed by Hussain et al showed that 20.0% (9 women) in sitting position group while only 4.4% (2 women) in lateral position group had post dural puncture headache. 2 Similarly, the results of another study conducted by Demilew et al also corroborated that later position is better than sitting position with regards to post dural puncture headache.…”

“…The findings of our research are comparable with a most recent research undertaken by Doğukan et al who reported that mean age of the women in sitting position group was 29.23 + 5.09 years while in lateral position group was 29.39 + 4.28 years. 22 Another study carried out by Dinesh et al indicated that mean age of the women in sitting position group was 25.333 + 2.229 years while in left lateral position group was 26.083 + 3.263 years. 5 Similarly in another study, mean age of the women in sitting position group was 26.7 + 4.8 years while in lateral position group was 26.4 + 4.8 years.…”

“…The prevalence of nausea & vomiting among patients of sitting position was 58.5 percent and 75.5 percent while in lateral position group was 76.5 percent and 90.2 percent, respectively. 22 A recent study performed by Kumar and companions elucidated that the incidence of post-dural puncture headache was found more among patients in sitting position group (12.0%) when compared with patients in lateral position group (1.0%) in 1st postoperative day. 23 A meta-analysis conducted by Zorrilla-vaca and fellows demonstrated that the lateral decubitus position was related to a significant decrease in the PDPH incidence when compared to the sitting position.…”

"Remimazolam for Sedation with Preserved Spontaneous Respiratory Intubation: Experience of Airway Management in an Obesity Patient with Severe Trauma"

“…For lower extremity surgery, if there are no contraindications, we usually have the option of spinal block or nerve block anesthesia to complete the procedure. Spinal block and nerve block anesthesia require postural placement [7,8], and this patient was unable to cooperate with postural placement due to trauma and obesity from multiple fractures throughout the body. The patient had a large area of trauma to the left leg, and simple nerve block anesthesia was not adequate.…”