POSTURE AND THE SPREAD OF HYPERBARIC BUPIVACAINE IN PARTURIENTS USINGTHE COMBINED SPINAL EPIDURAL TECHNIQUE

This study was undertaken to analyze the effect of posture on the spre ad of hyperbaric bupivacaine in pregnant women using a combined spinal extradural technique, and to assess the quality of analgesia provided by 10 mg bupivacaine when using this technique. Fifty parturients und ergoing elective Caesarean section wider regional anaesthesia were ran domly allocated to receive 2.0 ml hyperbaric bupivacaine 0.5% in eithe r the sitting or left lateral position. Spinal injection was performed with a 27 gauge, 120 mm long spinal needle using a single space combi ned spinal extradural technique. The onset time to analgesia at T4, an d grade 3 motor block was on average 77 min and 6 9 min respectively i n the lateral group, compared with 10.8 min (P < 0.05) and 9.4 min (P < 0.05) in the sitting group. Nine women in the sitting group and one woman (P < 0.05) in the lateral group required epidural supplementatio n. Hypotension occurred in 48% of the parturients in the lateral group and in 13% (P < 0.05) of the parturients in the sitting group. Nausea was noted in 61% of the parturients in the lateral group and in 22% ( P < 0.05) of the parturients in the sitting group. There was no differ ence between the two groups in neonatal outcome. Overall, the position of the patient during induction of spinal anaesthesia does influence the rate of onset of analgesia and motor blockade. Injection of 10 mg hyperbaric bupivacaine in the sitting position would not provide adequ ate analgesia for Caesarean section when using a single space combined spinal extradural techique.