Impact of being lateral and sitting position for spinal anesthesia administration on maternal hemodynamic variability and the timing of hypotension among cesarean section patients in a resource-constrained area: a prospective observational cohort study.

Abstract

Background: Type of anesthesia used for cesarean section can be general, spinal, or epidural. However, peripheral nerve blocks, such as the lower and upper extremity nerve blocks, can be referred to as other types of anesthesia. Spinal anesthesia is the most frequently used method because of its ease, dependability, and rapidity in attaining proper anesthesia. The purpose of this study was to determine the effects of spinal anesthesia induction position on maternal hemodynamics and the timing of hypotension.

Method: A prospective observational cohort study design was employed. A simple random sampling technique was used. A total of 190 patients received spinal anesthesia, with 95 in the lateral and 95 in the sitting position in each group. The data were entered into Epi Data version 4.6 and then exported to SPSS version 26 for analysis. Independent sample t-tests and chi-square (χ ²) tests were performed. Kaplan-Meier survival analysis and log-rank test were used and P value ≤0.05 considered significant.

Results: The overall incidence rates of hypotension in the lateral and sitting groups were 54.6% [95% CI, 52.3-72.1] and 73.8% [95% CI, 69.8-87.2], respectively (P = 0.025). The timing of first hypotension was 8.86 minute [95% CI, 8.690-13.272] and 15.75 minute [95% CI, 14.569-19.372] (P = 0.001) for sitting and lateral, respectively.

Conclusion and recommendation: In this study, we found a significant difference between the lateral and sitting groups with different measurement parameters, such as blood pressure, intraoperative adverse events, and onset of hypotension. The incidence of hypotension, intraoperative adverse effects of spinal anesthesia, and fluid consumption were lower in the lateral groups. Nonetheless, instead of being technically challenging during spinal anesthesia induction, the lateral position results in better hemodynamics and onset of hypotension than in the sitting posture.