Comparing Three Different Modified Sitting Positions for Ease of Spinal Needle Insertion in Patients Undergoing Spinal Anesthesia

Sussan Soltani Mohammadi, Mohammadreza Piri, Alireza Khajehnasiri, Sussan Soltani Mohammadi, Mohammadreza Piri, Alireza Khajehnasiri

Abstract

Background: The most important point for performing a neuroaxial block in a sitting position is reducing lumbar lordosis, resulting in easier access to interspinous space and dura mater. There are a few studies comparing 2 different sitting positions including a traditional sitting position (TSP) versus forward bending or hamstring stretch position (HSP) as well as TSP versus squatting position (SP) for reversing the lumbar lordosis and improving access to intervertebral space for neuroaxial block.

Objectives: We compared 3 different sitting positions including traditional sitting position vs. hamstring stretch position vs. squatting position and hypothesized that squatting position reverses the lumbar lordosis and reduces the number of spinal needle bone contacts more than TSP and HSP.

Methods: A total of Thirty hundred and sixty ASA class I or II patients aged 18 to 60 years were scheduled for elective surgeries under spinal anesthesia were randomized into 3 groups. Our primary endpoint was the number of spinal needle-bone contacts and our secondary endpoint was ease of needle insertion or space identification.

Results: Demographic data were statistically different between the study groups. There was no statistical difference between the study groups regarding the number of needle bone contacts and the ease of finding intervertebral space (P = 0.63, P = 0.56, respectively).

Conclusions: There was no statistical difference between the TSP, HSP, and SP regarding the number of needle bone contacts and the ease of finding of intervertebral space. In this regard, each of these 3 positions can be used as an alternative sitting position for administration of spinal anesthesia.

Keywords: Hamstring Stretch Position; Spinal Anesthesia; Spinal Needle; Squatting Position; Traditional Sitting Position.

Figures

Figure 1.. Depicture of Patient in Traditional…
Figure 1.. Depicture of Patient in Traditional Sitting Position
Figure 2.. Depicture of Patient in Squatting…
Figure 2.. Depicture of Patient in Squatting Position
Figure 3.. Depicture of Patient in Hamstring…
Figure 3.. Depicture of Patient in Hamstring Stretch Position
Figure 4.. Comparing Study Groups Regarding the…
Figure 4.. Comparing Study Groups Regarding the Number of Needle Bone Contacts

References

    1. Biswas BK, Agarwal B, Bhattarai B, Dey S, Bhattacharyya P. Straight versus flex back: Does it matter in spinal anaesthesia? Indian J Anaesth. 2012;56(3):259–64. doi: 10.4103/0019-5049.98772.
    1. Tashayod ME, Tamadon S. Spinal block in sitting position without moving the legs. Middle East J Anaesthesiol. 1980;5(8):529–33.
    1. Fisher KS, Arnholt AT, Douglas ME, Vandiver SL, Nguyen DH. A randomized trial of the traditional sitting position versus the hamstring stretch position for labor epidural needle placement. Anesth Analg. 2009;109(2):532–4. doi: 10.1213/ane.0b013e3181ac6c79.
    1. Soltani Mohammadi S, Hassani M, Marashi SM. Comparing the squatting position and traditional sitting position for ease of spinal needle placement: a randomized clinical trial. Anesth Pain Med. 2014;4(2):e13969. doi: 10.5812/aapm.13969.
    1. Manggala SK, Tantri AR, Satoto D. Comparison of Successful Spinal Needle Placement Between Crossed-Leg Sitting Position and Traditional Sitting Position in Patients Undergoing Urology Surgery. Anesth Pain Med. 2016;6(4):e39314. doi: 10.5812/aapm.39314.
    1. Garcia AM, Martí A, Rodriguez PM, Villamor M, Martínez A, Moral MV. Predictors of difficulty in neuroaxial block: A prospective study. Eur J Anaesthesiol. 2011;28:110. doi: 10.1097/00003643-201106001-00351.
    1. de Filho GR, Gomes HP, da Fonseca MH, Hoffman JC, Pederneiras SG, Garcia JH. Predictors of successful neuraxial block: a prospective study. Eur J Anaesthesiol. 2002;19(6):447–51. doi: 10.1097/00003643-200206000-00008.
    1. Tanaka K, Irikoma S, Kokubo S. Identification of the lumbar interspinous spaces by palpation and verified by X-rays. Braz J Anesthesiol. 2013;63(3):245–8. doi: 10.1016/S0034-7094(13)70224-1.
    1. Fettes PD, Jansson JR, Wildsmith JA. Failed spinal anaesthesia: mechanisms, management, and prevention. Br J Anaesth. 2009;102(6):739–48. doi: 10.1093/bja/aep096.
    1. Sprung J, Bourke DL, Grass J, Hammel J, Mascha E, Thomas P, et al. Predicting the difficult neuraxial block: a prospective study. Anesth Analg. 1999;89(2):384–9.
    1. Atallah MM, Demian AD, Shorrab AA. Development of a difficulty score for spinal anaesthesia. Br J Anaesth. 2004;92(3):354–60. doi: 10.1093/bja/aeh073.
    1. Kim JH, Song SY, Kim BJ. Predicting the difficulty in performing a neuraxial blockade. Korean J Anesthesiol. 2011;61(5):377–81. doi: 10.4097/kjae.2011.61.5.377.
    1. Movasseghi G, Hassani V, Mohaghegh MR, Safaeian R, Safari S, Zamani MM, et al. Comparison between spinal and general anesthesia in percutaneous nephrolithotomy. Anesth Pain Med. 2014;4(1):e13871. doi: 10.5812/aapm.13871.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere