M. Patel et al., POSTURE AND THE SPREAD OF HYPERBARIC BUPIVACAINE IN PARTURIENTS USINGTHE COMBINED SPINAL EPIDURAL TECHNIQUE, Canadian journal of anaesthesia, 40(10), 1993, pp. 943-946
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.