Comparison of three sitting positions for combined spinal - epidural anesthesia: a multicenter randomized controlled trial

Mehmet Özgür Özhan; Ceyda Özhan Çaparlar; Mehmet Anıl Süzer; Mehmet Burak Eskin; Bülent Atik

doi:10.1016/j.bjane.2020.12.012

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Comparison of three sitting positions for combined spinal - epidural anesthesia: a multicenter randomized controlled trial

Journal article

Open access

Peer reviewed

Comparison of three sitting positions for combined spinal - epidural anesthesia: a multicenter randomized controlled trial

Mehmet Özgür Özhan, Ceyda Özhan Çaparlar, Mehmet Anıl Süzer, Mehmet Burak Eskin and Bülent Atik

Brazilian journal of anesthesiology (Elsevier), Vol.71(2), pp.129-136

03/01/2021

DOI: 10.1016/j.bjane.2020.12.012

PMCID: PMC9373673

PMID: 33894856

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https://doi.org/10.1016/j.bjane.2020.12.012View

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Abstract

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. 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. 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). 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.

Arthroplasty

Combined spinal epidural anesthesia

Hamstring stretch position

Squatting position

Traditional sitting position

Details

Title: Subtitle: Comparison of three sitting positions for combined spinal - epidural anesthesia: a multicenter randomized controlled trial
Creators: Mehmet Özgür Özhan - Türk Anesteziyoloji ve Reanimasyon Derneği
Ceyda Özhan Çaparlar - Ankara Yıldırım Beyazıt University
Mehmet Anıl Süzer - Türk Anesteziyoloji ve Reanimasyon Derneği
Mehmet Burak Eskin - Ankara (Czechia)
Bülent Atik - Balıkesir University
Resource Type: Journal article
Publication Details: Brazilian journal of anesthesiology (Elsevier), Vol.71(2), pp.129-136
DOI: 10.1016/j.bjane.2020.12.012
PMID: 33894856
PMCID: PMC9373673
NLM abbreviation: Braz J Anesthesiol
ISSN: 0104-0014
eISSN: 0104-0014
Publisher: Elsevier Editora Ltda
Language: English
Date published: 03/01/2021
Academic Unit: Anesthesia
Record Identifier: 9984656538202771

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