ALTERNATING PATIENT POSITION FOLLOWING THE INDUCTION OF OBSTETRIC EPIDURAL ANALGESIA DOES NOT AFFECT LOCAL-ANESTHETIC SPREAD

To assess the influence of gravity on epidural-induced sensory blockad e during the first stage of labour, 60 parturients were recruited to a randomized, controlled, single-blinded study. In all cases an epidura l catheter was placed with the patient in the left lateral position. T hereafter, patients were randomized to one of three groups. In group s upine (S), the epidural injection was performed in the supine position with a 15-20 degrees right flank elevation and the patient remained s upine. In group left (L) patients remained in the left lateral positio n for 10 min after injection. In group left and right (L+R) patients r emained in the left lateral position for 5 min and then assumed the ri ght lateral position for 5 min. Thereafter, in groups L and L+R patien ts lay supine with a 15-20 degrees right flank elevation. All patients received 50 mu g fentanyl in 10 mi of 0.125% bupivacaine. Ten minutes after injection loss of pinprick and temperature sensation were asses sed and pain scores measured. Height of sensory deficit 10 min after i njection and after maximal blockade were unaffected by patient positio n. In all cases maximal blockade reached Ts or higher. Time to maximal block was 14.7 +/- 2.3 min, 14.1 +/- 1.6 min and 13.9 +/- 1.5 min for groups L, L+R and S respectively. After maximal blockade, pain scores were significantly (P <0.0001) decreased in all groups, with no diffe rences between them. We conclude that position immediately following l ocal anaesthetic drug administration has little effect on onset and di stribution of epidural analgesia.