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The Trendelenburg position increases the spread and accelerates the onset of epidural anesthesia for Cesarean section

[La position de Trendelenburg permet une plus grande distribution de l'anesthésie épidurale et en accélère le début d'action lors de la césarienne]

Ahmad R. Setayesh, MD^*, Ali R. Kholdebarin, MD^*, Masoud Saber Moghadam, MD^* and Hamid R. Setayesh, MD

^* From the Department of Anesthesiology, School of Medicine, Iran University oof Medical Sciences and Healt Services (iums) and
Statistical and Research Consultant, Council for Planning in Therapeutic Affairs, Iranian Ministry of Health & Medical Education, Tehran, Iran.

Address correspondence to: Dr. A.R. Setayesh, Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran 14455, Iran. Phone: ++98 21 8083029; Fax: ++98 21 8590054; E-mail: Setayesh{at}iums.ac.ir

Purpose: The effect of position on the spread and the onset time of epidural anesthesia has not been well documented. This study was undertaken to assess the effect of modified Trendelenburg position on the spread of epidural anesthesia for Cesarean section.

Methods: Seven hundred thirty-nine parturients underwent epidural anesthesia for elective or emergent Cesarean section. Patients were divided into two groups in a randomized-controlled study. All patients received 20 mL of 2% lidocaine injected through a 19G epidural needle, a standard technique in our institution. During induction of epidural anesthesia, the first group was placed in 15 Trendelenburg with 10 head-up position and the second in the horizontal position. The onset time and the level of anesthesia, patients' vital signs, and Apgar score were recorded in both groups.

Results: There were no significant differences in vital signs, oxygen saturation and Apgar score between the two groups. The results show significant differences in the time of onset (on average four minutes faster in the modified Trendelenburg position group) (P <0.001), and in achieving T5 level sensory blockade (97.5% vs 42.8%) between the modified Trendelenburg and horizontally positioned pregnant women.

Conclusion: This study demonstrates that the modified Trendelenburg position has a significant effect on the spread and the onset time of single shot epidural anesthesia, and can be used safely in term parturients for emergency or elective Cesarean section.

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