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Title: Comparison of Hemodynamic Effects and Patient Satisfaction Between Lateral Versus Sitting Maternal Positions for Cesarean Deliveries in Spinal Anesthesia
Authors: Saleem Parvaiz Bajwa, Akhtar Hussain, Abdullah, Muhammad Akram, Sajid Shahzad, Umer Khan
Journal: Pakistan Armed Forces Medical Journal (PAFMJ)
Publisher: Army Medical College, Rawalpindi.
Country: Pakistan
Year: 2024
Volume: 74
Issue: 4
Language: English
Keywords: AnesthesiaCesarean SectionHemodynamicsSpinal.
Objective: To compare the hemodynamic effects of spinal anesthesia in sitting vs. lateral maternal positions in terms of patient comfort and anesthetist convenience.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Lahore Pakistan, from Jun 2018 to Dec 2018.
Methodology: Two hundred and sixteen patients admitted for Cesarean deliveries were randomly selected and divided into two groups of 108 each for spinal anesthesia in sitting (S-Group) or lateral (L-Group) positions. Baseline heart rate and blood pressure were recorded and readings for both were measured after every two minutes for 15 minutes. Hypotension and bradycardia were noted and treated. Patients were interviewed afterwards for comfort in sitting or lateral position and the number of spinal anesthesia attempts made were also recorded.
Results: In L-Group, 36(33%) patients had hypotension while 60(55.5%) had hypotension in S-Group. In L-Group, 4(3.7%) patients and 8(7.4%) patients in S-Group had bradycardia. Six patients (5.5%) in the Lateral-Group and 13(12%) in Sitting-Group required therapy for which the p-value came out to be significant. In Lateral-Group, 98 patients (90.7%) were comfortable and 9(8.3%) were uncomfortable, 1(0.97%) was agitated whereas in Sitting-Group 78(72%) were comfortable, 25(23%) were uncomfortable and 5(5%) were agitated. Subarachnoid puncture was 87% successful in S-Group and 74% successful in L-Group in 1st attempt.
Conclusion: Lateral spinal position was more comfortable with better hemodynamics however sub arachnoid puncture was easier in sitting position.
To compare the hemodynamic effects of spinal anesthesia in sitting versus lateral maternal positions in terms of patient comfort and anesthetist convenience.
A quasi-experimental study was conducted with 216 patients undergoing Cesarean deliveries. Patients were randomly divided into two groups of 108: one receiving spinal anesthesia in the sitting position (S-Group) and the other in the lateral position (L-Group). Hemodynamic parameters (heart rate and blood pressure) were recorded every two minutes for 15 minutes post-anesthesia. Hypotension and bradycardia were noted and treated. Patient comfort and the number of spinal anesthesia attempts were also recorded. Data was analyzed using SPSS version 24.0, with Chi-square test applied for inferential statistics.
graph TD
A["Recruit 216 Patients for Cesarean Delivery"] --> B["Randomly Assign to Sitting"S-Group" or Lateral"L-Group" Position"];
B --> C["Administer Spinal Anesthesia"];
C --> D["Record Hemodynamic Parameters HR, BP every 2 mins for 15 mins"];
D --> E["Note and Treat Hypotension/Bradycardia"];
E --> F["Record Patient Comfort Level"];
F --> G["Record Number of Spinal Anesthesia Attempts"];
G --> H["Analyze Data using SPSS"];
H --> I["Compare Hemodynamic Effects and Patient Satisfaction"];
The lateral position was found to be more comfortable for patients and resulted in better hemodynamic stability, with lower incidences of hypotension and bradycardia compared to the sitting position. However, the sitting position was more convenient for anesthetists and had a higher success rate for the first spinal anesthesia attempt. The study acknowledges that while the lateral position offers better patient outcomes regarding hemodynamics and comfort, the sitting position may be preferred by anesthetists due to ease of access and landmark identification.
- Hypotension occurred in 55.5% of patients in the Sitting Group compared to 33% in the Lateral Group.
- Bradycardia occurred in 7.4% of patients in the Sitting Group compared to 3.7% in the Lateral Group.
- Therapy for hemodynamic instability was required by 12% of patients in the Sitting Group and 5.5% in the Lateral Group (p<0.05).
- 90.7% of patients in the Lateral Group reported comfort, while 72% in the Sitting Group reported comfort.
- Subarachnoid puncture was successful on the first attempt in 87% of patients in the Sitting Group versus 74% in the Lateral Group.
Initiating spinal anesthesia for Cesarean deliveries in the lateral position provides better hemodynamic stability and patient comfort compared to the sitting position. While the sitting position is more convenient for anesthetists and offers a higher success rate for the initial puncture, experience and practice can improve success rates in the lateral position.
- Hypotension incidence in the sitting group was 55.5%, while in the lateral group it was 33%.
- 90.7% of patients in the Lateral Group reported being comfortable.
- Subarachnoid puncture was successful on the first attempt in 87% of patients in the Sitting Group.
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