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How Long Can Patients Sit Up for Before Lying Down after Combined Spinal-Epidural Anesthesia For Cesarean Delivery? A Randomized Trial

EE Abd El-Hakeem, Kaki AM, Alhashemi JA, Boker AM and Albasri SF

Objective: Sitting patients up for 5 min after spinal anesthesia decreases hypotension and ephedrine requirement. This study aimed at determining how long patients can sit up for after combined spinal-epidural (CSE) anesthesia without requiring epidural supplementation. Methods: Ninety women booked for elective cesarean section under CSE anesthesia were randomized to sit up for 5 min (group 1), 7 min (group 2), or 9 min (group 3) after spinal anesthetic administration before lying down supine with a tilt. Sensory anesthesia level, systolic blood pressure, heart rate, ephedrine requirement, rescue epidural use, and time to achieving a modified Bromage score of two were documented by a blinded observer. Results: The maximum height of sensory anesthesia was [T3 (1) vs. T4 (1) vs. T5 (1) for groups 1-3, respectively, P<0.001]. Group 1 required more ephedrine (16.7% vs. 3.3% vs. 0%, P=0.024). Changes over time in systolic blood pressure (P=0.117) and heart rate (P =0.793), and time to achieving a modified Bromage score of two [112 (17) vs. 110 (16) vs. 100 (28) min, P=0.437] were similar amongest groups. Rescue epidural anesthesia was required in eight (26.7%) patients in group 3 compared to none in the other groups (P<0.001). Conclusion: Sitting the patient up for up to 7 min after CSE anesthesia for cesarean section reduced intraoperative ephedrine requirement without affecting the success of the spinal anesthetic. In contrast, sitting up for 9 min resulted in the need for rescue epidural anesthesia without additional benefit.