Thoracic vs Lumbar Spinal Anesthesia for Cesarean Delivery

Comparison of Thoracic Segmental Spinal Anesthesia Versus Lumbar Spinal Anesthesia on Postoperative Recovery in Patients Undergoing Cesarean Section: A Randomized Controlled Trial

This randomized controlled trial aims to compare the effects of thoracic segmental spinal anesthesia and conventional lumbar spinal anesthesia on postoperative recovery in patients undergoing elective cesarean section. Postoperative recovery will be assessed using the ObsQoR-11 score. Hemodynamic parameters, vasopressor and anticholinergic requirements, perioperative complications, and mobilization time will also be evaluated.

Study Overview

• Status: Not yet recruiting
• Conditions: Cesarean Sections
• Intervention / Treatment: Procedure: Lumbar Spinal Anesthesia; Procedure: Thoracic Segmental Spinal Anesthesia

Detailed Description

Cesarean delivery is most commonly performed under lumbar spinal anesthesia; however, thoracic segmental spinal anesthesia has emerged as a potential alternative that may provide more segmental block with improved hemodynamic stability and recovery profile. This study will randomize patients to receive either lumbar spinal anesthesia at L3-4 or L4-5 levels or thoracic segmental spinal anesthesia at T10-11 or T11-12 levels. The primary outcome is postoperative recovery assessed by ObsQoR-11. Secondary outcomes include intraoperative hemodynamic changes, vasopressor (ephedrine) and atropine consumption, incidence of nausea and vomiting, post-dural puncture headache, and time to first mobilization.

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: NEZİR YILMAZ, Associate Professor; Phone Number: +905068939496; Email: yilmaznezir@hotmail.com

Study Locations

• Turkey (Türkiye)
  • Adıyaman Province
    • Adıyaman, Adıyaman Province, Turkey (Türkiye), 02200
      • Adıyaman University Training and Research Hospital
      • Contact: NEZİR YILMAZ; Phone Number: 05068939496; Email: yilmaznezir@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Pregnant women scheduled for elective cesarean section
• ASA II-III
• Age 18-45 years

Exclusion Criteria:

• Contraindications to spinal anesthesia
• Coagulopathy or anticoagulant use
• Infection at puncture site
• Severe cardiac disease
• Patient refusal

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Lumbar Spinal Anesthesia; Participants in this group will receive conventional spinal anesthesia performed at the lumbar interspace (L3-4 or L4-5). The goal is to achieve a standard sensory block level adequate for cesarean delivery. All procedures will be performed by experienced anesthesiologists under standardized conditions. Intraoperative management, including hemodynamic support and fluid administration, will follow the same institutional protocol as in the thoracic group.	Procedure: Lumbar Spinal Anesthesia; Participants in this group will receive conventional spinal anesthesia performed at the lumbar interspace (L3-4 or L4-5)
Experimental: Thoracic Segmental Spinal Anesthesia; Participants allocated to this group will receive spinal anesthesia performed at the thoracic interspace (T10-11 or T11-12). The technique will aim to achieve a segmental sensory block sufficient for cesarean delivery while minimizing cephalad spread. Caudal spread of the local anesthetic will be limited in order to avoid unnecessary lower extremity motor block, thereby potentially facilitating earlier postoperative mobilization. All procedures will be performed by experienced anesthesiologists under standardized monitoring conditions. Intraoperative management, including fluid therapy and vasopressor administration, will be standardized according to institutional protocols.	Procedure: Thoracic Segmental Spinal Anesthesia; Thoracic Segmental Spinal Anesthesia: Spinal anesthesia will be performed at the thoracic interspace (T10-11 or T11-12) Lumbar Spinal Anesthesia: Spinal anesthesia will be performed at the lumbar interspace (L3-4 or L4-5); Other Names: Lumbar Spinal Anesthesia

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Obstetric Quality of Recovery-11 score	Quality of recovery was assessed using the Obstetric Quality of Recovery-11 (ObsQoR-11) questionnaire. Each item is scored from 0 to 10, yielding a total score ranging from 0 to 110, where 110 indicates the best possible recovery and 0 indicates the worst.	Postoperative 24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean arterial pressure	Mean arterial pressure (MAP), defined as the time-weighted average arterial pressure over a single cardiac cycle, was calculated using the standard formula: MAP = [(2 × diastolic blood pressure) + systolic blood pressure] / 3. Continuous or intermittent MAP measurements were used to assess hemodynamic stability and adequacy of organ perfusion throughout the perioperative period. Intraoperative hypotension was predefined as a MAP <6o mmHg.	0, 5, 15, 30, 45 minutes intraoperatively
Heart rate	Heart rate (HR), expressed as beats per minute (bpm), was continuously monitored using standard electrocardiography. HR was used as an indicator of autonomic and hemodynamic response throughout the perioperative period. Tachycardia was predefined as HR >100 bpm and bradycardia as HR <50 bpm.	0. - 5. - 15. - 30. - 45. minutes intraoperatively
Time to first mobilization		Up to 24 hours postoperatively

Other Outcome Measures

Outcome Measure	Time Frame
Incidence of nausea and vomiting	perioperatively and postoperative first 24 hours
Rate of Post-dural puncture headache	Postoperative 48 hours

Collaborators and Investigators

• Sponsor: Adiyaman University Research Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): May 5, 2026
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): July 15, 2026

Study Registration Dates

• First Submitted: April 23, 2026
• First Submitted That Met QC Criteria: April 28, 2026
• First Posted (Actual): May 5, 2026

Study Record Updates

• Last Update Posted (Actual): May 5, 2026
• Last Update Submitted That Met QC Criteria: April 28, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: cesarean section; Quality of recovery; Thoracic segmental spinal anesthesia; Lumbar spinal anesthesia
• Other Study ID Numbers: ADYU-ANS-NY-013

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No