Maternal Position and Development of Hypotension in Patients undergoing Cesarean Section under Combined Spinal–Epidural Anesthesia of Intrathecal Hyperbaric Ropivacaine

Background: Spinal anesthesia (SA) is usually associated with hypotension in pregnant women. We sought to assess the influence of various maternal positions on SA-induced hypotension
Material and Methods: The study population comprised 99 women at full-term gestation scheduled for elective cesarean section. They were randomized into 3 equal groups: the LL group, in which the patient was placed in the full left-lateral position until the start of surgery with the Whitacre needle bevel oriented laterally; the LS group, in which the patient was placed in the full left-lateral position initially and then shifted to the left-tilt supine position with the needle bevel oriented laterally; and the CS group, in which the patient was initially placed in the full left-lateral position and then shifted to the left-tilt supine position with the needle oriented in the cephalad direction.
Results: The incidences of hypotension in the LL, LS, and CS groups were 9.7%, 54.8%, and 56.3%, respectively. Ephedrine requirements were lower in the LL group than in the LS group (P<0.01).
Conclusions: The maternal position during the induction of anesthesia played an important role in the development of hypotension during cesarean delivery.

Keywords: Amides - administration & dosage, Adult, Anesthesia, Epidural - methods, Anesthesia, Spinal - methods, Anesthetics, Local - adverse effects, Blood Pressure, Cesarean Section - methods, Hemodynamics, Hypotension - etiology, Nerve Block, Pregnancy, Supine Position - physiology, Uterus - blood supply