Razia Hussain, Saira Jamshed, Farah Khan, Sariya Bin Naseem Khan, Zainab S Khan, Munira Murtaza Khomusi.
Lateral versus sitting positions during induction of spinal anesthesia for elective cesarean section: a Comparative Study.
Pak J Surg Jan ;35(3):224-9.

Introduction: There is a rapid increase in cesarean section rates throughout the world. Positioning of patients before giving spinal anesthesia has been a topic of immense interest amongst anesthesiologists. Many authors have investigated postures such as left lateral and right lateral positions as well sitting positions during induction of spinal anesthesia and studied the effect of postures on parameters such as spread of sensory blockade, occurrence of hypotension, and incidence of post Dural Puncture Headache. We conducted this comparative study to analyse the effect of positioning (sitt ing versus lateral) on sensory and motor blockade as well as on hemodynamic stability and incidence of postdural puncture headache (PDPH). Materials and Methods: 90 women posted for elective cesarean section and belonging to ASA I and II from 1st March 2015 till 28 February 2017 were included in this study on the basis of a predefined inclusion and exclusion criteria. Out of 90 studied cases 45 patients were given Spinal Anesthesia in sitting position (group-A) whereas in remaining 45 patients induction of spinal was done in left lateral decubitus position (group-B). Th e effect of positioning (sitting versus lateral) on sensory and motor blockade as well as on hemodynamic stability and incidence of PDPH was compared in studied cases. P value less than 0.05 was taken as statistically significant. Results: Demographic factors such as mean age and weight and ASA grades of the studied cases were found to be comparable with no statistically significant difference between the studied groups (P>0.05). Sensory blockade at 5 minutes and motor blockade at 3 minutes was found to be statistically significantly different in both the groups. Th ere was a drop in mean arterial pressure in patients of sitting group after they were given supine position which is reflected in the readings at 5,10 and 15 minutes. 9 patients in sitting group and 2 patients in lateral group had bothersome headache. The difference was found to be statistically significant (P<0.05). Conclusion: Lateral decubitus position as compared to sitting position while doing induction of spinal anesthesia appears to be a better choice for patients undergoing elective cesarean section.

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