Comparison of vasovagal shock incidence during spinal anesthesia in sitting and lateral position

Abstract

Introduction & aim of the study: Spinal anesthesia was the first regional anesthetic technique to be employed, the conventional procedure (sitting position) and the lateral position are two of the most well-known methods for administering spinal anesthesia. Vasovagal shock (syncope) (VVS) is a type of reflex syncope that can be induced by a variety of factors, including pain, the injection of neuraxial anesthesia, emotional or orthostatic stress and other factors. So in this study, we attempt to compare the incidence of vasovagal shock (VVS) during spinal anesthesia in sitting and lateral position.

Material and method: The patients in this study were blinded to how they received the spinal anesthesia using various approaches because the trial was carried out using a randomized single-blinded study design, following that, they were divided into two groups non-randomly based on their position during spinal anesthesia administration, and the dural puncture performed by spinal needle 25 GA, 12-15 mg (2.5-3 ml) of hyperbaric bupivacaine and slow speed of injection was 1 ml/30s for both groups.

Result: The mean age of participants in this study, which included 60 patients, was 29.4 ± 4.5 years. The incidence of vasovagal response was 4-5 % in the previous study population. Our findings revealed that among all participants, 6.7 % of vasovagal shock incidence with spinal anesthesia occurred in these situations, and it was divided by 5% (3 patients) when spinal anesthesia is given in the sitting position and 1.7% (just 1 patient) when it is given in the lateral position, (p<0.05) that’s mean there is high significant difference between these two techniques.

Conclusion: Regarding that vasovagal shock occurring to a smaller number of participants when administering spinal anesthesia in the lateral position, the results clearly preference administering spinal anesthesia in the lateral position over the sitting position in terms of the number of samples that had this condition (VVS) in each group when it compared according most variables like age, gender, other complications and cardiopulmonary changes. Also, in term of the presence of other side effects (hypotension, headache, shivering, sweating, nausea, and others) which were limited and less severity than those with the sitting position, it’s also indicated the advantage for the lateral spinal anesthesia technique.