ORIGINAL ARTICLE-Effect of time spent in sitting

position after induction of spinal anesthesia with

hyperbaric (0.75%)bupivacaine in patients who require
perineal or urethral surgery.
Dr Nasrullah Khan ,FCPS asstt.professor anesthesiology.Dr Tariq saeed,FCPS
asstt.professor general surgery.
Department of anesthesiology,intensive care and pain management fauji
foundation hospital Lahore.

ABSTRACT
Ojective:We conducted this study conclude that time spent in sitting position after
induction of spinal anesthesia has no significant effect on upper level of spinal block
and on hemodynamic status of patient.This study was carried out to save the time
because there is too long list of patients requiring operation on a particular day.
The study was conducted in fauji foundation hospital Lahore in department of
anesthesiology in close collabaration with surgical department of the hospital.
Study design:An interventional comparative study.
Methods :Eighty patient under going perineal and urethral surgery were selected
for the study and were randomly divided into four groups,having number of twenty
in each group.All patients were between the age group of 30-50 years and were in
ASA 1 OR ASA II.Patients with systemic illness and positional problems were
excluded from study.
Results:All four groups did not differ much as far as the upper level of spinal block
and hemodynamic stability was concerned however attaining the higher level of
block was earlier in groups where time given in sitting position was short.
Conclusion:there is no advantage in keeping the patient in sitting position for long
time after induction of spinal anesthesia just of fear of side effects.It is rather
wastage of time and at time dangerous for patient because of pooling of blood in
dependent parts of body.
Key words:spinal anesthesia;bupivacaine,hemodynamic changes and positional
effects.

INTRODUCTION

Clinical studies have shown that the characteristics of neural block after
subarachnoid administration of hyperbaric bupivacaine change with
increasing age.1 3 In particular, the level of analgesia extends
approximately three to four segments higher in elderly compared with
young adult patients. Old age and high levels of analgesia appear to be
the two main factors associated with the development of hypotension
during spinal anaesthesia.4 The degree of hypotension correlates with the
level of sympathetic block, which is generally two to four segments higher
than the level of analgesia.5 From a clinical point of view, it is, therefore,
important to limit the level of sympathetic block. A spinal technique that
prevents unnecessary high levels of analgesia and sympathetic block in
elderly patients is,
therefore, recommended. One of the benets claimed for hyperbaric
solutions is that their spread can be controlled by posture.6 The position of
the patient at the time of injection may affect the direction of
subarachnoid distribution, at least initially. There is, however, still
discussion about the duration of the sitting period that is needed to limit
the spread of analgesia.7 9