The comparison of combined spinal-epidural anesthesia performed in either sitting or lateral positions in cesarean section

THE COMPARISON OF COMBINED SPINAL-EPIDURAL ANESTHESIAPERFORMED IN EITHER SITTING OR LATERAL POSITIONS IN CESAREANSECTIONDr. Ece Dumanlar TanWe aimed to compare quality of anesthesia, maternal hemodynamics and ephedrine usewhen combined spinal-epidural anesthesia (CSEA) induction is performed in either sitting orright lateral decubitus positions in parturients scheduled to undergo cesarean section (C/S), inorder to show relatively better induction position according to the maternal hemodynamicsand technical aspects.Sixty ASA I-II women having >36 weeks?gestation were allocated into 2 groups toperform CSEA in either sitting (Group I) or right lateral decubitus (Group II) position. Thehemodynamics, peripheral oxygen saturation (SpO2), sensory and motor block characteristicswere recorded by every 2 minutes in the first 10 minutes followed by 5 minutes in the firsthour and every 10 minutes until the end of the surgery. The first analgesic requirement, thecomplications and the number of attempts during CSEA induction, intraoperative andpostoperative complications were recorded. Apgar scores of the newborn were noted.There were no significant differences between the groups with respect to ephedrine usebut peroperative maternal hemodynamics was comparable except. Unless the sensory blockwas significantly higher in the right lateral decubitus position. Despite the similar motor blockregression times between the groups, the regression of sensory block and the first analgesicrequirements were longer in right lateral decubitus position than that of sitting position.Incidence of paraesthesia was lower and CSEA was easier in the sitting position. Nosignificant differences were found between the groups in the complications.In conclusion, sitting position can be preferred for parturients scheduled C/S underCSEA because of maternal hemodynamics was affected relatively more due to the higher andrapid onset of sensorial block, and the number of attemps for identification of epidural spaceand the incidence of paraesthesia during the insertion of the spinal needle were greater in theright lateral decubitus position with respect to sitting position though the amount of ephedrineuse was similar during the induction of CSEA in both positions.