Effects of tilting in the sagittal plane on the cephalad spread of anesthesia

The effect of tilting in the sagittal plane on the spread of anesthesia was studied in 30 healthy male patients. Two ml of 0.3% hyperbaric dibucaine was used for intrathecal injection in the lateral position. After 3 min of resting on their side, 15 patients were placed in the horizontal supine position. Other 15 patients were turned to the contralateral side at 7-8 degrees in the sagittal plane. Cephalad spread of sensory analgesia by the pin-prick method, degree of motor blockade by Bromage score, mean arterial pressure, and heart rate were assessed. Mean spread of sensory analgesia in the non-dependent side on the dural puncture was significantly higher in the sagittal-tilt group (T7.4 +/- 2.6 at 15 min) compared the horizontal group (T9.5 +/- 1.4 at 15 min). There was no significant difference in the mean cephalad spread of the analgesic level in the dependent side between the two groups. Unilateral motor anesthesia of the dependent side seemed to be canceled by the sagittal tilting maneuver. A 7 to 8 degree tilt in the sagittal plane is recommended to facilitate the cephalad spread of analgesia and to avoid unilateral anesthesia.