Archives of Anesthesiology and Critical Care 2015. 1(2):55-58.

The Effect of Trendelenburg Posture on Sensory Block Level in Spinal Anesthesia with Intrathecal Hyperbaric Bupivacaine for Hernia Repair
Ali Shahriari, Maryam Khooshideh, Reyhane Heidari, Shahriar Haddady Abianeh, Mahdi Sheikh, Shahrokh Ghazizadeh, Javad Rahmati


Background: Obtaining a good sensory and motor block is the goal of performing spinal anesthesia for surgeries. The aim of this study is to compare the effect of trendelenburg position on sensory block level after spinal anesthesia with intrathecal hyperbaric bupivacine.

Methods: We enrolled 80 men, classified as ASA I, scheduled for elective hernia repair under spinal anesthesia. Participants were randomly allocated equally to one of the two groups, horizontal or trendelenburg position. Spinal anesthesia was performed in the sitting position using 15 mg of 0.5% hyperbaric bupivacaine. Then the patients were turned to supine position. In trendelenburg position group, a 20 degree head tilt position was performed for 40 seconds, then the patients were returned to horizontal position and 30 mg ephedrine was administered intramuscularly. Sensory block level and incidence of hypotension were recorded in the two groups.

Results: There were significant effects of trendelenburg position on sensory block heights during the study period (10.61 ± 0.32segments blocked above the injection point versus 7.24 ± 0.51 in horizontal group).  No episodes of severe hypotension were seen among the patients. Six patients in horizontal group experienced intraoperative discomfort or pain, versus no patient in Trendelenburg group. (p=0001).

Conclusion: A higher level of sensory block can be obtained with performing a short time head down position after intrathecal injection.


spinal anesthesia; bupivacaine; trendelenburg position; sensory block level

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Russell IF. Effect of posture during the induction of sub arachnoid analgesia for Caesarean section: right v. left lateral. Br J Anaesth. 1987; 59(3):342-6.

Russell IF. Posture and isobaric subarachnoid anesthesia. Anaesthesia. 1984; 39(9):865-7.

Santos A, Pedersen H, Finster M, Endström M. Hyperbaric bupivacaine for spinal anesthesia in cesarean section. Anesth Analg. 1984; 63(11):1009-13.

Richardson MG, Collins HV, Wissler RN. Intrathecal hypobaric versus hyperbaric bupivacaine with morphine for cesarean section. Anesth Analg. 1998; 87(2):336-40.

Van Gessel EF, Forster A, Schweizer A, Gamulin Z. Comparison of hypobaric, hyperbaric, and isobaric solutions of bupivacaine during continuous spinal anesthesia. Anesth Analg. 1991; 72(6):779-84.

Inglis A, Daniel M, McGrady E. Maternal position during induction of spinal anaesthesia for caesarean section: A comparison of right lateral and sitting positions. Anaesthesia. 1995; 50(4):363-5.

Yun EM, Marx GF, Santos AC. The effects of maternal position during induction of combined spinal-epidural anesthesia for cesarean delivery. Anesth Analg. 1998; 87(3):614-8.

Sia AT, Tan KH, Sng BL, Lim Y, Chan ES, Siddiqui FJ. Use of hyperbaric versus isobaric bupivacaine for spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2013; 5:CD005143.

Lowson SM, Brown J, Wilkins CJ. Influence of the lum bar interspace chosen for injection on the spread of hyper baric 0.5% bupivacaine. Br J Anaesth. 1991; 66(4):465-8.

Sinclair CJ, Scott DB, Edström HH. Effect of the trendelenberg position on spinal anaesthesia with hyperbaric bupivacaine. Br J Anaesth. 1982; 54(5):497-500.

Tecklenburg-Weier E, Quest F, Nolte H, Meyer J. The effect of patient positioning on the spread of sensory blockade in hyperbaric and isobaric spinal anesthesia using bupivacaine. Reg Anaesth. 1990; 13(7):163-7.

Thage B, Callesen T. Bupivacaine in spinal anesthesia. The spread of analgesia--dependence on baricity, positioning, dosage, technique of injection and patient characteristics. Ugeskr Laeger. 1993; 155(39):3104-8.

Greene NM. Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg. 1985; 64(7):715-30.

Pitkanen M, Rosenberg PH. Local anaesthetics and additives for spinal anaesthesia: Characteristics and factors influencing the spread and duration of the block. Best Pract Res Clin Anaesthesiol. 2003; 17(3):305-22.

Bannister J, McClure JH, Wildsmith JA. Effect of glucose concentration on the intrathecal spread of 0.5% bupivacaine. Br J Anaesth. 1990; 64(2):232-4.

Stienstra R, Greene NM. Factors affecting the subarachnoid spread of local anesthetic solutions. Reg Anesth. 1991; 16(1):1-6.

Richardson MG, Thakur R, Abramowicz JS, Wissler RN. Maternal posture influences the extent of sensory block produced by intrathecal dextrose-free bupivacaine with fentanyl for labor analgesia. Anesth Analg. 1996; 83(6):1229-33.

Hallworth SP, Fernando R, Columb MO, Stocks GM. The effect of posture and baricity on the spread of intrathecal bupivacaine for elective cesarean delivery. Anesth Analg. 2005; 100(4):1159-65.

Loubert C, Hallworth S, Fernando R, Columb M, Patel N, Sarang K, et al. Does the baricity of bupivacaine influence intrathecal spread in the prolonged sitting position before elective cesarean delivery? A prospective randomized controlled study. Anesth Analg. 2011; 113(4):811-7.

Tecklenburg-Weier E, Quest F, Nolte H, Meyer J. The effect of patient positioning on the spread of sensory blockade in hyperbaric and isobaric spinal anesthesia using bupivacaine. Reg Anaesth. 1990; 13(7):163-7.

Kim JT, Shim JK, Kim SH, Jung CW, Bahk JH. Trendelenburg position with hip flexion as a rescue strategy to increase spinal anaesthetic level after spinal block. Br J Anaesth. 2007; 98(3):396-400.

Ali Hassan HI. Comparison between two different selective spinal anesthesia techniques in ambulatory knee arthroscopy as fast-track anesthesia. Anesth Essays Res. 2015; 9(1):21-7.

Heng Sia AT, Tan KH, Sng BL, Lim Y, Chan ES, Siddiqui FJ. Hyperbaric versus plain bupivacaine for spinal anesthesia for cesarean delivery. Anesth Analg. 2015; 120(1):132-40.

Shahriari A, Khooshideh M. Intrathecal fentanyl added to lidocaine for Cesarean delivery under spinal anesthesia-a randomised clinical trial. Middle East J Anaesthesiol. 2007; 19(2):397-406.

Cantürk M, Kılcı O, Ornek D, Ozdogan L, Pala Y, Sen O, et al. Ropivacaine for unilateral spinal anesthesia; hyperbaric or hypobaric? Rev Bras Anestesiol. 2012; 62(3):298-311.

Shahriari A, Khooshideh M, Heidari MH. A Proposed Management of Accidental Intrathecal Injection of a Wrong Drug: Spinal Washing. J Appl Environ Biol Sci. 2014; 4(8) 292-295.


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