Canadian Journal of Anesthesia, Vol 40, 943-946, Copyright © 1993 by Canadian Anesthesiologists' Society

ARTICLES

Posture and the spread of hyperbaric bupivacaine in parturients using the combined spinal epidural technique

M Patel, G Samsoon, A Swami and B Morgan
Department of Anaesthesia, Queen Charlotte's and Chelsea Hospital, London.

This study was undertaken to analyze the effect of posture on the spread of hyperbaric bupivacaine in pregnant women using a combined spinal extradural technique, and to assess the quality of analgesia provided by 10 mg bupivacaine when using this technique. Fifty parturients undergoing elective Caesarean section under regional anaesthesia were randomly allocated to receive 2.0 ml hyperbaric bupivacaine 0.5% in either the sitting or left lateral position. Spinal injection was performed with a 27 gauge, 120 mm long spinal needle using a single space combined spinal extradural technique. The onset time to analgesia at T4, and grade 3 motor block was on average 7.7 min and 6.9 min respectively in the lateral group, compared with 10.8 min (P < 0.05) and 9.4 min (P < 0.05) in the sitting group. Nine women in the sitting group and one woman (P < 0.05) in the lateral group required epidural supplementation. Hypotension occurred in 48% of the parturients in the lateral group and in 13% (P < 0.05) of the parturients in the sitting group. Nausea was noted in 61% of the parturients in the lateral group and in 22% (P < 0.05) of the parturients in the sitting group. There was no difference between the two groups in neonatal outcome. Overall, the position of the patient during induction of spinal anaesthesia does influence the rate of onset of analgesia and motor blockade. Injection of 10 mg hyperbaric bupivacaine in the sitting position would not provide adequate analgesia for Caesarean section when using a single space combined spinal extradural technique.

This article has been cited by other articles:

				Y. Lim, W. Teoh, and A. T. Sia Combined Spinal Epidural Does Not Cause a Higher Sensory Block than Single Shot Spinal Technique for Cesarean Delivery in Laboring Women Anesth. Analg., December 1, 2006; 103(6): 1540 - 1542. [Abstract] [Full Text] [PDF]

				H. C. Coppejans, E. Hendrickx, J. Goossens, and M. P. Vercauteren The Sitting Versus Right Lateral Position During Combined Spinal-Epidural Anesthesia for Cesarean Delivery: Block Characteristics and Severity of Hypotension Anesth. Analg., January 1, 2006; 102(1): 243 - 247. [Abstract] [Full Text] [PDF]

				A. C. S. Law, K. K. Lam, and M. G. Irwin The Effect of Right Versus Left Lateral Decubitus Positions on Induction of Spinal Anesthesia for Cesarean Delivery Anesth. Analg., December 1, 2003; 97(6): 1795 - 1799. [Abstract] [Full Text] [PDF]

				E. Crosby Clinical case discussion: anesthesia for Cesarean section in a parturient with a large intrathoracic tumour : [Expose clinique : l'anesthesie pour une cesarienne chez une parturiente qui presente une grosse tumeur intrathoracique] Can J Anesth, June 1, 2001; 48(6): 575 - 583. [Abstract] [Full Text]