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The Trendelenburg position increases the spread and accelerates the onset of epidural anesthesia for Cesarean section

La position de Trendelenburg permet une plus grande distribution de l’anesthésie épidurale et en accélère le début d’action lors de la césarienne

Canadian Journal of Anesthesia volume 48, pages 890–893 (2001)Cite this article

Résumé

Objectif

L’effet de la position sur la distribution de l’anesthésie épidurale et sur le délai d’installation n’ont pas été bien documentés. La présente étude est entreprise pour évaluer l’effet de la position de Trendelenburg modifiée sur la distribution de l’anesthésie épidurale pendant la césarienne.

Méthodes

Sept cent trente-neuf parturientes ont reçu une anesthésie épidurale pour une césarienne élective ou urgente. Divisées en deux groupes, dans une étude randomisée et contrôlée, toutes les patientes ont reçu 20 mL de lidocaïne à 2 % administrée avec une aiguille épidurale 19G, la technique standard dans notre établissement. Le premier groupe a été placé en position de Trendelenburg à 15°, la tête élevée à 10° et le deuxième en position horizontale. Le délai d’installation et le niveau de l’anesthésie, les signes vitaux de la mère, l’indice d’Apgar ont été évalués dans les deux groupes.

Résultats

La pression artérielle, la fréquence cardiaque, la saturation du sang artériel en oxygène, et l’indice d’Apgar n’ont pas présenté de différence significative intergroupe selon les positions de Trendelenburg modifiée ou horizontale. Les résultats montrent des différences significatives de délai d’installation (environ quatre minutes plus rapide dans le groupe en position de Trendelenburg modifiée) (P < 0,001 ) et d’atteinte d’un bloc sensoriel au niveau T5 entre les groupes dans les positions Trendelenburg modifiée et horizontale ( 97,5 % contre 42,8 % respectivement).

Conclusion

Cette étude démontre que la position de Trendelenburg modifiée a un effet significatif sur l’étendue de l’anesthésie épidurale et qu’elle peut être utilisée sans risque chez les parturientes à terme, candidates à la césarienne urgente ou élective.

Abstract

Purpose

The effect of position on the spread and the onset time of epidural anesthesia has not been well documented. This study was undertaken to assess the effect of modified Trendelenburg position on the spread of epidural anesthesia for Cesarean section.

Methods

Seven hundred thirty-nine parturients underwent epidural anesthesia for elective or emergent Cesarean section. Patients were divided into two groups in a randomized-controlled study. All patients received 20 mL of 2% lidocaine injected through a 19G epidural needle, a standard technique in our institution. During induction of epidural anesthesia, the first group was placed in 15 Trendelenburg with 10 head-up position and the second in the horizontal position. The onset time and the level of anesthesia, patients’ vital signs, and Apgar score were recorded in both groups.

Results

There were no significant differences in vital signs, oxygen saturation and Apgar score between the two groups. The results show significant differences in the time of onset (on average four minutes faster in the modified Trendelenburg position group) (P < 0.001), and in achieving T5 level sensory blockade (97.5% vs 42.8%) between the modified Trendelenburg and horizontally positioned pregnant women.

Conclusion

This study demonstrates that the modified Trendelenburg position has a significant effect on the spread and the onset time of single shot epidural anesthesia, and can be used safely in term parturients for emergency or elective Cesarean section.

References

  1. Apostolou GA, Zarmakoupis PK, Mastrokostopoulos GT. Spread of epidural anesthesia in the lateral position. Anesth Analg 1981; 60: 584–6.

    PubMed  Article  CAS  Google Scholar 

  2. Grundy EM, Rao LN, Winnie AP. Epidural anesthesia and the lateral position. Anesth Analg 1978; 57: 95–7.

    PubMed  CAS  Google Scholar 

  3. Norris MC, Leighton BL, DeSimone CA, Larijani GE. Lateral position and epidural anesthesia for cesarean section. Anesth Analg 1988; 67: 788–90.

    PubMed  CAS  Google Scholar 

  4. Merry AF, Cross JA, Mayadeo SV, Wild CJ. Posture and the spread of extradural analgesia in labour. Br J Anaesth 1983; 55: 303–6.

    PubMed  Article  CAS  Google Scholar 

  5. Grundy EM, Zamora AM, Winnie AP. Comparison of spread of epidural anesthesia in pregnant and nonpregnant women. Anesth Analg 1978; 57: 544–6.

    PubMed  Article  CAS  Google Scholar 

  6. Husemeyer RP, White DC. Lumbar extradural injection pressures in pregnant women. An investigation of relationships between rate of injection, injection pressures and extent of analgesia. Br J Anaesth 1980; 52: 55–60.

    PubMed  Article  CAS  Google Scholar 

  7. Ponhold H, Kulier AH, Rehak PH. 30 trunk elevation of the patient and quality of epidural anesthesia. Effects of elevation in operations on the lower extremities (German). Anaesthesist 1993; 42: 788–92.

    PubMed  CAS  Google Scholar 

  8. Norris MC, Dewan DM. Effect of gravity on the spread of extradural anaesthesia for cesarean section. Br J Anaesth 1987; 59: 338–41.

    PubMed  Article  CAS  Google Scholar 

  9. Whalley DG, D’Amico JA, Rybicki LA, et al. The effect of posture on the induction of epidural anesthesia for peripheral vascular surgery. Reg Anesth 1995; 20: 407–11.

    PubMed  CAS  Google Scholar 

  10. White N. Cephalad spread of epidural blockade in a 15-degree head-down position (Letter). Anesthesia 1999; 54: 1019–20.

    Article  CAS  Google Scholar 

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Author information

Affiliations

  1. Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences and Health Services(IUMS), Iran

    Ahmad R. Setayesh, Ali R. Kholdebarin & Masoud Saber Moghadam

  2. Statistical and Research consultant, Council for Planning in Therapeutic Affairs, Iranian Ministry of Health & Medical Education, Tehran, Iran

    Hamid R. Setayesh

Authors
  1. Ahmad R. Setayesh
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  2. Ali R. Kholdebarin
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  3. Masoud Saber Moghadam
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  4. Hamid R. Setayesh
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Corresponding author

Correspondence to Ahmad R. Setayesh.

Additional information

This work should be attributed to the Department of Anesthesiology, Iran University of Medical Sciences & Health Services (IUMS).

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Setayesh, A.R., Kholdebarin, A.R., Moghadam, M.S. et al. The Trendelenburg position increases the spread and accelerates the onset of epidural anesthesia for Cesarean section. Can J Anesth 48, 890–893 (2001). https://doi.org/10.1007/BF03017356

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Keywords

  • Cesarean Section
  • Epidural Anesthesia
  • Apgar Score
  • Epidural Blockade
  • Cephalad Spread