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Purpose

Multiple studies have compared spinal anesthetic performed supine versus lateral, with varying results, in parturients having elective cesarean section. Needle positioning during spinal placement has also been examined. No positioning techniques have demonstrated definitive superiority for hemodynamic stability. Investigators propose that following spinal placement in the sitting position if the patient is placed in a lateral position for 90 seconds prior to turning them supine, hemodynamic changes caused by sympathectomy related to the subarachnoid block can be avoided. This is the first study to examining the influence of position changes after spinal anesthetic placement in the sitting position, which includes hemodynamic variables not previously studied including cardiac output, TPR (total peripheral resistance) and pulse pressure variation (PPV).

Conditions

Eligibility

Eligible Ages
Over 18 Years
Eligible Genders
Female
Accepts Healthy Volunteers
No

Inclusion Criteria

  • Parturients undergoing elective cesarean section under spinal anesthesia - Singleton intrauterine pregnancy with appropriate gestational age fetus (AGA) at gestational age 37 to 42 weeks

Exclusion Criteria

  • Large for gestational age, small for gestational age, and multiple gestations - Patients with cardiovascular disease like hypertension, etc. - Non-English or non-Spanish speakers - BMI >40 - Inadequate or failed blocks and inadvertently high levels of spinal blockade will be dropped from the study - Incarcerated parturients - Expected heavy bleeding (placenta accreta, vascular anomaly, etc.)

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Prevention
Masking
Single (Outcomes Assessor)

Arm Groups

ArmDescriptionAssigned Intervention
Sham Comparator
Supine position 		Supine position Supine position after placement of spinal anesthetic
  • Other: Supine position
    Spinal anesthesia in sitting position then 2 minutes in Supine position after spinal anesthetic administration
Active Comparator
Right lateral position 		Right lateral position Right lateral after placement of spinal anesthetic
  • Other: Right lateral position
    Spinal anesthesia in sitting position then 2 minutes in the right lateral position after spinal anesthetic administration
Active Comparator
Left lateral position 		Left lateral position Left lateral after placement of spinal anesthetic
  • Other: Left lateral position
    Spinal anesthesia in sitting position then 2 minutes in the left lateral position after spinal anesthetic administration

More Details

Status
Completed
Sponsor
The University of Texas Medical Branch, Galveston

Study Contact

Detailed Description

Cesarean section is chosen when natural spontaneous vaginal delivery is either not possible or when the health of the baby or mother is compromised. Cesarean section may be planned, urgent, or performed emergently when the life of the baby or mother is threatened. Cesarean section is performed using different anesthetic techniques including: spinal, epidural, combined spinal and epidural, and general anesthesia. Spinal anesthesia is the most common technique chosen due to its relative safety, rapid onset and avoidance of potential complications from general anesthesia. It is the technique of choice for elective cesarean section unless contraindicated. Spinal anesthesia causes sympathetic blockade followed by sensory and motor blockade. Nerve fiber size explains the speed of onset and differential block. The critical moments during spinal anesthesia come as soon as local anesthetic is injected into the subarachnoid space.

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.