Maternal position and development of hypotension in patients undergoing cesarean section under combined spinal-epidural anesthesia of intrathecal hyperbaric ropivacaine

Med Sci Monit. 2015 Jan 5:21:52-8. doi: 10.12659/MSM.892224.

Abstract

Background: Spinal anesthesia (SA) is usually associated with hypotension in pregnant women. We sought to assess the influence of various maternal positions on SA-induced hypotension

Material/methods: The study population comprised 99 women at full-term gestation scheduled for elective cesarean section. They were randomized into 3 equal groups: the LL group, in which the patient was placed in the full left-lateral position until the start of surgery with the Whitacre needle bevel oriented laterally; the LS group, in which the patient was placed in the full left-lateral position initially and then shifted to the left-tilt supine position with the needle bevel oriented laterally; and the CS group, in which the patient was initially placed in the full left-lateral position and then shifted to the left-tilt supine position with the needle oriented in the cephalad direction.

Results: The incidences of hypotension in the LL, LS, and CS groups were 9.7%, 54.8%, and 56.3%, respectively. Ephedrine requirements were lower in the LL group than in the LS group (P<0.01).

Conclusions: The maternal position during the induction of anesthesia played an important role in the development of hypotension during cesarean delivery.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Amides / administration & dosage*
  • Anesthesia, Epidural / adverse effects
  • Anesthesia, Epidural / methods*
  • Anesthesia, Spinal / adverse effects
  • Anesthesia, Spinal / methods*
  • Anesthetics, Local / adverse effects
  • Blood Pressure
  • Cesarean Section / methods*
  • Female
  • Hemodynamics
  • Humans
  • Hypotension / etiology*
  • Nerve Block
  • Pregnancy
  • Ropivacaine
  • Supine Position / physiology*
  • Uterus / blood supply*

Substances

  • Amides
  • Anesthetics, Local
  • Ropivacaine