Post-spinal position and its impact on hemodynamic, block height, and comfort in caesarean delivery: A randomized...

Maternal hypotension is common during spinal anesthesia for cesarean delivery and is influenced by patient position. Positioning also affects sensory block height, which determines visceral analgesia. This study compared immediate supine, sitting, and semi-sitting positions to identify the optimal balance between cardiovascular stability and surgical anesthesia.

In this randomized controlled trial, 216 ASA II term parturients scheduled for cesarean delivery under spinal anesthesia were assigned to three groups (n = 72). Group A received immediate supine positioning, Group B sat for three minutes, and Group C assumed semi-sitting for three minutes. All received 2.5 mL of 0.5% hyperbaric bupivacaine. The primary outcome was maternal hypotension; secondary outcomes included block height, intraoperative discomfort, vasopressor use, and neonatal Apgar scores.

Hypotension occurred most in Group A (65.3%), followed by Group C (47.2%) and Group B (33.3%) (P < .001). The supine group had 3.79 times higher odds of hypotension compared with sitting. Ephedrine use was greatest in Group A (14.5 ± 3.2 mg) and least in Group B (8.1 ± 2.3 mg). Median block height was T3 in Group A, T5 in Group C, and T6 in Group B. Intraoperative discomfort was highest in Group B (22.2%) compared with Group C (12.5%) and Group A (5.6%) (P = .009). Hypotension correlated with nausea, most frequent in Group A (19.4%). Neonatal Apgar scores were ≥8 at 1 and 5 min in all groups.

Maternal position after spinal anesthesia significantly influences hemodynamics and block height. Sitting reduces hypotension but risks lower block and discomfort, while semi-sitting provides a favorable compromise.

[NCT06857162].