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BJA Advance Access originally published online on February 5, 2007
British Journal of Anaesthesia 2007 98(3):396-400; doi:10.1093/bja/ael370
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Trendelenburg position with hip flexion as a rescue strategy to increase spinal anaesthetic level after spinal block{dagger}

J.-T. Kim1, J.-K. Shim2, S.-H. Kim2, C.-W. Jung1 and J.-H. Bahk1,*

1 Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
2 Department of Anesthesiology and Pain Medicine, Yonsei University Hospital, Seoul, Korea

* Corresponding author: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #28 Yongon-Dong, Jongno-Gu, Seoul 110-744, Korea. E-mail: bahkjh{at}plaza.snu.ac.kr

BACKGROUND: When the level achieved by a spinal anaesthetic is too low to perform surgery, patients are usually placed in the Trendelenburg position. However, cephalad spread of the hyperbaric spinal anaesthetics may be limited by the lumbar lordosis. The Trendelenburg position with the lumbar lordosis flattened by hip flexion was evaluated as a method to extend the analgesic level after the administration of hyperbaric local anaesthetic.

METHODS: When the pinprick block level was lower than T10 5 min after intrathecal injection of hyperbaric bupivacaine (13 mg), patients were recruited to the study and randomly allocated to one of the two positions: the Trendelenburg position with hip flexion (hip flexion group, n = 20) and the Trendelenburg position without hip flexion (control group, n = 20). Each assigned position was maintained for 5 min and then patients were returned to the horizontal supine position. Spinal block level was assessed by pinprick, cold sensation, and modified Bromage scale at intervals for the following 150 min.

RESULTS: The maximum level of pinprick and cold sensory block [median (range)] was higher in the hip flexion group [T4 (T8–C6) and T3 (T6–C2)] compared with the control group [T7 (T12–T4) and T5 (T11–T3)] (P < 0.001). The maximum motor blockade median (range) was not different between the two groups being 3 (3–3) in the hip flexion group vs 3 (0–3) in the control group.

CONCLUSIONS: When the level of spinal anaesthesia is lower than required, flexion of the hips in the Trendelenburg position may be useful as a strategy attempt to increase the level of the block.

Keywords: anaesthetic techniques, subarachnoid; anaesthetics local, bupivacaine; position, Trendelenburg

{dagger} Presented in part at the International Anesthesia Research Society Annual Meeting, San Francisco, USA, March, 2006.


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