Comparison of outcome of sitting versus lateral position undergoing spinal anesthesia for cesarean section
INTRODUCTION: In obstetrics, both regional and general anaesthesia are acceptable for patients planned for caesarean section. However, regional anesthesia is favored in obstetrics because it is more advantageous for both the mother and the child as compared to general anaesthesia. The complications of general anaesthesia include difficult or failed intubation, pulmonary aspiration, atonic uterus in the mothers and respiratory depression due to anesthetic drugs in both the mothers and the child.
OBJECTIVE: To compare outcomes of sitting versus lateral position in patients undergoing spinal anaesthesia for caesarean section in terms of frequencies of hemodynamic stability and patients comfort.
MATERIAL AND METHODS
Settings and duration: Department of anaesthesia and critical care, mother and child health center, P.L.M.S, Islamaba, during 06 months from February 21, 2016 to August 20, 2016.
Study design: Randomized controlled trial.
Data collection procedure: All the normal healthy patient, with BMI under 30, nonsmokers with good exercise tolerance or with mild with mild systemic disease were included. Informed consent was taken and patient was allotted to a study group as either group S or group L by a lottery method on arrival to the operation theatre (with two 18G iv lines in situ). By starting on with standard monitoring (ECG, NIBP, SpO2) the patient was preloaded with 20ml/kg of ringer lactate. Patient's position was made according to allocated group and baseline parameters were noted before the procedure with the patient's blood pressure and heart rate recorded as time'0'. Under aseptic measures, spinal anaesthesia was performed with a 25G quincke shaped spinal needle. A total dose of 3ml (0.5%) hyperbaric bupivacaine was given in the subarachnoid space over 20 seconds at the level of L3-L4. The patient was helped to turn back to the supine position immediately after the spinal anaesthesia procedure.
Results: Total 130 patients were included according to the inclusion criteria. Mean age in both the groups was 28.02+14.51 and 27.74+5.14 whereas mean body mass index in both the groups was 18.37+0.30 and 17.70+2:59 respectively. There were 18 (27.7) and 24 (36.9) patients in both the groups who have hypotension which was statistically not significant (p-value 0.260) and 03 (4.6) patients presented with bradycardia which was statistically not significant (p-value 0.310). In the study, there were 10 (15.4) and 20 (30,8) caesarean patients in both the groups who feel very comfortable undergoing spinal anaesthesia which was statistically significant (p-value 0.004).
Conclusion: The study concludes that both sitting and lateral positions have similar effects in terms of level of comfort and hemodynamic stability. However, patients generally found lateral position very comfortable.
Key words: Spinal Anaesthesia, Cesarean section, Lateral position
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