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

Özhan M. Ö. , Çaparlar C. Ö. , Süzer M. A. , Eskin M. B. , Atik B.

Brazilian journal of anesthesiology (Elsevier), vol.71, no.2, pp.129-136, 2021 (Peer-Reviewed Journal) identifier identifier

  • Publication Type: Article / Article
  • Volume: 71 Issue: 2
  • Publication Date: 2021
  • Doi Number: 10.1016/j.bjane.2020.12.012
  • Journal Name: Brazilian journal of anesthesiology (Elsevier)
  • Journal Indexes: Science Citation Index Expanded, Scopus, Directory of Open Access Journals
  • Page Numbers: pp.129-136
  • Keywords: Arthroplasty, Combined spinal epidural anesthesia, Hamstring stretch position, Squatting position, Traditional sitting position


Copyright © 2020. Published by Elsevier Editora Ltda.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.