Spinal block levels and cardiovascular changes during post-Cesarean transport

Transport after surgery under spinal anesthesia is associated with cardiovascular changes. The extensively vasodilated patient may be unable to compensate for postural blood flow redistribution. This observational study investigated pre- and post-surgery sensory levels as well as hemodynamic changes during the postoperative transfer period.

One hundred ninety nine women, ASA 1 and 2, undergoing Cesarean section under spinal anesthesia were studied at the end of surgery. Hyperbaric bupivacaine 12-15 mg and morphine 0.25 mg were the agents used. Patients in group A (n = 111) were transferred to the Recovery Room on a stretcher with the upper body flexed 30 degrees head up: patients in group B (n = 88) remained supine during transport.

At the end of Cesarean section 95% of patients had upper sensory levels of T4 and higher. In 17.5% the block ascended 2-7 dermatomes compared with the pre-operative level. The incidence of hypotension on arrival in Recovery Room was similar in both groups (group A 10% and group B 9%).

These results draw attention to the persistence of extensive sympathetic block at the end of Cesarean section. Transport to the Recovery Room was associated with the development of considerable hypotension in 10% of patients and this was unaffected by position. We recommend recording the level of sensory block at the end of surgery and increased monitoring during transport to the Recovery Room.