Background: Hypotension is one of the common complications in patients undergoing surgeries under spinal anesthesia. This phenomenon is
comparatively more in pregnant women undergoing caesarean section under spinal anesthesia due to anatomical variations in the spinal cord and
physiological changes in pregnant women. Maternal position may inuence the spread of the local anaesthetic drug. So, in this study we have
aimed to compare incidence of hypotension and various other parameters like onset of sensory and motor blockade, total number of
mephentermine incremental doses (5mg/dose) required in each group to correct hypotension after induction of spinal anesthesia in sitting and
lateral position for caesarean sections.
Methods: Seventy American Society of Anesthesiologists physical status I and II patients undergoing elective caesarean section were randomnly
divided into two groups by closed envelope technique to receive spinal anaesthesia in the lateral position (Group L) or the sitting position (Group
S). In Lumbar (L3interspace, lumbar puncture was done after taking aseptic precautions, plain bupivacaine 0.5% heavy 10 or 12 mg according to
the height was injected after conrming free ow of cerebro spinal uid. After this, they were placed in the supine position immediately with right
wedge providing for left lateral uterine displacement to avoid supine hypotension syndrome. Maternal blood pressure was measured every minute
for 5 minutes, every two min for 10 min and 5 minutely thereafter. Hypotension was dened as a fall in systolic blood pressure >20% of the baseline
value or a value <90 mmHg.
Results: Statistical studies showed that number of patients who received spinal anesthesia in lateral position had signicantly more incidences of
hypotension (19 incidences) compared to those who received in sitting position ( 10 incidences) with P value being (P= 0.048). And also there was
faster onset (average time) of action (sensory and motor) in Group L(5 minutes for sensory and 6.2 minutes for motor) than compared to Group S (7
minutes for sensory and 7.4 minutes for motor) but not statistically signicant ( P= 0.361 for sensory and 0.639 for motor). We also observed that,
total number of incremental doses (5mg/dose) of mephentermine used were more in patients who received spinal anaesthesia in lateral position (n=
10 increments) than compared to those who received in sitting position( n=5 increments) but it was not statistically signicant (P=0.145).
Conclusion: Spinal anesthesia given in lateral position of the patients for caesarean section causes signicantly more incidences of hypotension
than that given in sitting position. And there were no signicant differences with respect to onset of sensory and motor block and mephentermine
requirement between the groups.
The effects of spinal anaesthesia for elective caesarean section on uterine and umbilical arterial pulsatility indexes in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal study
