Posición tras la anestesia espinal y su impacto en la hemodinámica, altura del bloqueo y comodidad en el parto por cesárea: ensayo aleatorizad oculto para el evaluador

IF 1.3 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2026-04-01 Epub Date: 2026-03-25 DOI:10.1016/j.redar.2026.502089

A. Mohamady Eldemrdash, I. Elabd Hassan, A. Youssef Mohamed, H.M. Ahmed Raslan

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Abstract

Background

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.

Methods

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.

Results

Hypotension occurred most in Group A (65.3%), followed by Group C (47.2%) and Group B (33.3%) (p < 0.001). 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 = 0.009). Hypotension correlated with nausea, most frequent in Group A (19.4%). Neonatal Apgar scores were ≥8 at 1 and 5 minutes in all groups.

Conclusion

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.

Registration for the trial [NCT06857162].

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脊柱麻醉后的位置及其对血流动力学的影响、阻塞的高度和剖腹产的舒适性：供评估人员进行的隐藏随机试验

背景剖宫产脊柱麻醉时，母体低血压很常见，且受体位影响。体位也影响感觉阻滞高度，这决定了内脏镇痛。本研究比较了直接仰卧位、坐位和半坐位，以确定心血管稳定性和手术麻醉之间的最佳平衡。方法将216例麻下剖宫产的ASA II期足月产妇随机分为3组（n = 72）。A组立即仰卧位，B组坐位3分钟，C组半坐位3分钟。所有患者均接受2.5 mL 0.5%高压布比卡因。主要结局为产妇低血压；次要结局包括阻滞高度、术中不适、血管加压药物使用和新生儿Apgar评分。结果A组高血压发生率最高（65.3%），其次为C组（47.2%）和B组（33.3%）（p < 0.001）。仰卧组患低血压的几率是坐着组的3.79倍。麻黄碱用量A组最多（14.5±3.2 mg）， B组最少（8.1±2.3 mg）。A组中位阻滞高度为T3， C组为T5， B组为T6。术中不适以B组最高（22.2%），高于C组（12.5%）和A组（5.6%）（p = 0.009）。低血压与恶心相关，以A组最常见（19.4%）。各组新生儿Apgar评分均≥8分（1分钟和5分钟）。结论脊髓麻醉后产妇体位对血流动力学和阻滞高度有显著影响。坐着可以降低低血压，但有降低阻塞和不适的风险，而半坐则提供了有利的折衷方案。试验注册[NCT06857162]。

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