Sitting against Lateral Position for Spinal Anaesthesia in Elderly Patients Undergoing Lower Limb Surgeries: An Observational Study

Introduction: Age-related degenerative anatomical changes may make the spinal anaesthesia difficult. Sitting position is preferable due to easy identification of landmarks whereas lateral position is easy to maintain in case of elderly premedicated patients.

Aim: To compare the effects of spinal anaesthesia position (sitting versus lateral) in the elderly patients on block characteristics (sensory and motor), haemodynamic parameters, patient’s comfort and satisfaction.

Materials and Methods: The present prospective observational study was conducted in the Department of Anaesthesiology and Intensive care, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India, from November 2021 to May 2022. A total of 116 American Society of Anaesthesiologists (ASA) grade I-II patients of both sexes, age more than 70 years undergoing lower limb surgeries under spinal anaesthesia either sitting or lateral position were included in the study. These patients were divided in to two groups (sitting position-Group SP, lateral position-Group LP). Hyperbaric bupivacaine (0.5%) was injected into the subarachnoid space. After the spinal injection, assessments were made for block characteristics (sensory and motor), haemodynamic parameters and patient’s comfort and satisfaction. The discrete and categorical variables were analysed using Chi-square test.

Results: The mean age of participants in group SP and group LP was 77.31±4.015 years and 76.69±4.901 years, respectively. Onset of sensory block after was significantly slower in group SP (75.31±10.384 seconds) as compared to group LP (64.23±7.758 seconds). Time required to achieve maximum level of sensory block was significantly higher in group SP (8.11±1.416 minutes) than group LP (6.67±1.324 minutes). There was no significant difference in Heart Rate (HR) in both groups, but there was significantly lower Systolic Blood Pressure (SBP) in group SP than group LP upto 12 minutes after spinal injection. However, the lateral position appears to be more comfortable for elderly patients as per the comfort score.

Conclusion: Position for spinal anaesthesia, either sitting or lateral, has insignificant effects on block characteristics or on haemodynamic parameters except there was faster onset of sensory and motor block and more comfort in lateral position.