Keeping parturient in the left lateral position after spinal anesthesia with plain levobupivacaine at cesarean section reduces hypotension

None listed

Hypotension during spinal anesthesia is one of the main concerns in cesarean delivery. We hypothesized that keeping the parturients in the left lateral position for few minutes obtains dense anesthesia for the surgical site (below T10), and delayed placing to the supine position provides less dense anesthesia up to T5 to relieve the visceral part of surgical pain. Less dense anesthesia in the upper thoracic segments results in incomplete sympathetic block and low incidence of hypotension. Method: In this prospective study, 60 parturients undergoing cesarean section were randomized for turning to supine position just after subarachnoid injection of 2.5 mL 0.5% plain levobupivacaine in lateral position or to stay in lateral position for 15 minutes before supine positioning. Loss of pinprick sensation to T6 was accepted as adequate for cesarean section, and surgery proceeded. Characteristics of anesthesia, incidences of hypotension, bradycardia, other adverse events, and ephedrine use were assessed. Results: Compared to the supine group, the parturients kept in lateral position for 15 minutes experienced a marked decrease in the incidence of hypotension (33.3% vs. 83.3%, P<0.001) and adverse events related to hypotension such as nausea and vomiting (16.7% vs. 57.3%, P<0.001). In addition, ephedrine consumption per hypotension case was significantly reduced in the lateral group (5.4 +/- 4.7 mg vs 8.9 +/- 5.8, p<0.001). Conclusion: Keeping parturients in the lateral position for 15 minutes before turning to the supine position in cesarean section can provide a reliable spinal anesthesia with lower incidence and severity of hypotension and nausea/vomiting.

No related papers found yet.