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Year : 2013  |  Volume : 27  |  Issue : 1  |  Page : 70-74

Comparison of the lateral, Oxford and sitting positions for combined spinal and epidural anesthesia for elective caesarean section

Department of Anesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India

Correspondence Address:
N Ratan Singh
Department of Anesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-4958.116651

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Background: Combined spinal-epidural anesthesia (CSEA) is being increasingly used for elective caesarean section. We evaluated its effectiveness in three positions: The left lateral, the Oxford position, and the sitting position. Materials and Methods: One hundred and fifty parturients (aged 18-40 years and ASA I and II) undergoing elective caesarean section were enrolled in this prospective randomized study after obtaining written informed consent and institutional ethical clearance. CSEA was performed in the left lateral position (Group A, n = 50), the Oxford position (Group B, n = 50), and the sitting position (Group C, n = 50) using the single space needle through needle technique with Espocan epidural set (B ' Braun). Intrathecal injection of 2.2 ml of bupivacaine heavy 0.5% was given with 27 G spinal needle present in the set, and the parturient was positioned supine after the subarachnoid block. Epidural anesthesia was supplemented with 3 ml of 0.5% bupivacaine plain after a test dose with 2 ml of 2% xylocaine with adrenaline 1:200,000 only, if intrathecal block level did not reach T 4 dermatome level within 15 min. Injection mephenteramine 3 mg incremental doses were given intravenously to bring back the systolic blood pressure (SBP) > 100 mm Hg, and total mephenteramine consumption in each group was noted. Intraoperative hemodynamic parameters, the degree of motor blockade (modified Bromage score) and time to reach T 4 dermatome as well as post-operative complications were monitored. Results: Time to reach T 4 dermatome was minimum in the left lateral position (8.60 ± 3.11 min versus 12.70 ± 4.35 min in the Oxford position and 10.64 ± 3.63 min in the sitting position; P < 0.001). The incidence of hypotension was maximum in the left lateral position (Group A 42%; Group B 30% and Group C 26%; χ2 = 6.0 and P = 0.199). Similarly, mephenteramine consumption was also maximum in the left lateral position (2.52 ± 3.05 mg vs. 1.50 ± 2.32 mg in Group B and 1.20 ± 2.01 mg in Group C; P = 0.03). However, Group A patients had the least requirement for epidural supplementation (Group A, 2 parturients; Group B, 9 parturients; and Group C, 4 parturient; χ2 between A and B = 5.06; P = 0.03). Conclusion: The lateral position had the least requirement for epidural supplementation but required more vigilance because of faster and higher block and tendency for more episodes of hypotension.

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