Comparison of three sitting positions for combined spinal - epidural anesthesia: a multicenter randomized controlled trial
Brazilian Journal of Anesthesiology (English Edition), cilt.71, sa.2, ss.129-136, 2021 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 71 Sayı: 2
- Basım Tarihi: 2021
- Doi Numarası: 10.1016/j.bjane.2020.12.012
- Dergi Adı: Brazilian Journal of Anesthesiology (English Edition)
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Directory of Open Access Journals
- Sayfa Sayıları: ss.129-136
- Anahtar Kelimeler: Traditional sitting position, Hamstring stretch position, Squatting position, Combined spinal epidural anesthesia, Arthroplasty
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background and objectives: The aim of this prospective, multi-centered and multi-arm parallel randomized trial was to test the hypothesis that modified sitting positions including hamstring stretch position (HSP) and squatting position (SP) would reduce needle - bone contact events and increase the success rate of combined spinal - epidural anesthesia (CSEA) compared to traditional sitting position (TSP) in patients undergoing total knee or hip arthroplasty. Patients and methods: Three hundred and sixty American Society of Anesthesiologists (ASA) I-III patients, aged between 45-85 years were randomly allocated to one of three groups using computer-generated simple randomization: group TSP (n = 120), group HSP (n = 120), and group SP (n = 120). Primary outcome measures were the number of needle-bone contact and success rates. Secondary outcome measure was the ease of interspinous space identification. Results: Seven patients in group SP and four of HSP could not tolerate their position and were excluded. Number of needle-bone contact, success rates, and grade of interspinous space identification were similar between groups (p = 1.000). Independent of positioning, the success rates were higher in patients whose interspinous space was graded as easy compared to difficult or impossible (p < 0.001). Success rates reduced, interspinous space identification became more challenging, and number of needle – bone contact increased as patient's body mass index (BMI) increased (p < 0.001). Conclusion: SP and HSP may be used as alternatives to the TSP. BMI and ease of interspinous space identification may be considered important determinants for CSEA success.