Investigating the Effect of the 10° Reverse Trendelenburg Position on Spinal Block Characteristics and Hemodynamic Parameters in Lower Limb Surgeries.

Mahesh Rajwal,Sunil Thakur,Ravinder Verma,Shyam Bhandari,Aman Thakur,Bhanu Awasthi

doi:10.7759/cureus.22588

Abstract

Introduction: The primary goal of spinal anesthesia in lower limb surgeries is to achieve a successful sensory and motor block. Adequate level of spinal block for lower limb orthopedic surgery is T10. Due to multiple factors affecting the level of spinal anesthesia, it is not always easy to control the level of spinal anesthesia.We proposed that maintaining patients in a 10° reverse Trendelenburg position after spinal anesthesia can significantly control the height of the sensory block, resulting in stable hemodynamics.Materials and methods: This study is a single centric, prospective, single-blinded randomized clinical trial (CTRI/2018/08/015455) conducted in a tertiary care center in Sub-Himalayan region in India from July 2018 to June 2019. Total 60 patients fulfilling our inclusion and exclusion criteria were recruited in the study and were divided into two groups. In the supine group, patients were positioned in the supine position, and in the Trendelenburg group, patients were positioned in a 10° reverse Trendelenburg position after administering spinal anesthesia with 12.5 mg bupivacaine heavy. The two groups were compared in terms of sensory block, motor block, and analgesia duration. Heart rate, blood pressure, mean arterial pressure, and hypotension were also compared between the two groups.Results: Duration of sensory block, motor block, and analgesia were significantly higher in patients of the reverse Trendelenburg group (group T) compared to the supine group (group S). In group T, 26.6% had a sensory block level above T8, whereas in group S, 86.6% of patients had a sensory block level above T8. No hypotension was observed in the Trendelenburg group, which was present in 33% of patients in the supine group (group S).Conclusion: Ten-degree reverse Trendelenburg position immediately after giving spinal anesthesia significantly limits the level of sensory block and provides better hemodynamic stability, and can be more beneficial, especially in geriatric patients and other high-risk patients for lower limb surgeries.

Highlights

The primary goal of spinal anesthesia in lower limb surgeries is to achieve a successful sensory and motor block
We proposed that maintaining patients in a 10° reverse Trendelenburg position after spinal anesthesia can significantly control the height of the sensory block, resulting in stable hemodynamics
Patients were positioned in the supine position, and in the Trendelenburg group, patients were positioned in a 10° reverse Trendelenburg position after administering spinal anesthesia with 12.5 mg bupivacaine heavy

Summary

Introduction

The primary goal of spinal anesthesia in lower limb surgeries is to achieve a successful sensory and motor block. We proposed that maintaining patients in a 10° reverse Trendelenburg position after spinal anesthesia can significantly control the height of the sensory block, resulting in stable hemodynamics. Several factors including the age of patients, height and weight, local anesthetics, positioning of the patient being administered the anesthetic drug, dosage, injection technique, patient-specific symptoms, and needle level orientation are known to influence the level and duration of sensory block [1,2]. Higher degrees of spinal blockade result in a larger surface of absorption and diffusion, resulting in the elimination of a higher percentage of local anesthetic over time than lower levels, resulting in a shorter duration of anesthesia [5]. The position of a patient immediately after the intrathecal injection of local anesthetic agents affects not just the spread and the duration of the spinal blockade [6]. We sought to compare the reverse Trendelenburg position of 10° with the universal supine position in terms of block

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Conclusion