Spinal anesthesia with hypobaric bupivacaine for knee arthroscopies: Effect of posture on motor block

Background and Objectives: The clinical impact of patient positioning on mo tor block during unilateral spinal anesthesia was the focus of our study. I t was assumed that a 45 degrees rotation toward the prone position would mi nimize blocking the ventral motor roots compared with using the conventiona l lateral decubitus position. Methods: Spinal anesthesia with 3.4 mt of hypobaric 0.18% bupivacaine via a 27-gauge Whitacre needle was administered to 70 patients undergoing knee a rthroscopy. The patients were kept either in a lateral decubitus position ( group I) or rotated approximately 45 degrees toward the prone position (gro up TI). No prophylactic vasopressors or infusions were used. The intensity of motor block (modified Bromage scale) was assessed for both the operative and the contralateral side. Results: The patients in group I had a slightly more pronounced motor block , but statistical significance could he shown only 20 minutes following the block. There was no statistical difference between the groups in the need of additional analgesics during the operation. None of the patients needed general anesthesia. The hemodynamics were stable and none of the patients d eveloped postspinal headache or backache. Conclusions: The position of the patient affects the spread of the spinal a nesthesia when clearly hypobaric agents are used. However, this small modif ication in positioning of the patient did not lead to a clinically meaningf ul difference in the spread of the motor block.