Is Straight Back a Good Alternative to the Flexed Back for Spinal Anaesthesia?
Main Article Content
Abstract
Background: Spinal anaesthesia is generally performed with the patient’s back in flexed position so that the intervertebral spaces open up and the needle gets to the subarachnoid space without hitting the bone. However, in patient with lower limb fracture or orthopaedic disorders, it may not be possible to bend the back. Due to the ambiguity in literature with regard to the straight back as an alternative to the flexed back, the present study was conducted. Methods: 100 patients ASA grade I and II in the age group of 20-50 years scheduled for surgery under spinal anaesthesia were randomly allocated to straight back (SS group) and flexed back (SF) groups. The patients were informed that they would be placed in both flexed and straight postures before being placed in the final performing position, and both postures were explained to them to gauge their preference. The patient's level of comfort during the delivery of spinal anesthesia was rated as follows: There is no discomfort in Grade I, mild discomfort in Grade II, and severe discomfort in Grade III that requires changing positions. Ease of administration was assessed by quality of surface landmarks and number of bone contacts. Results: Spinal tap was successful on first attempt in 42 (84%) and 36 (72%) in group SF and SS respectively. Second attempt success was achieved in 8 (16%) and 14 (28%) in SF and SS group respectively. The quality of landmarks was grade 1 in 39 (78.0%), grade II in 11 (22%) patients in SF group. It was grade II in 11 (22%) in SF group and 21 (42%) patients in SS group. No patient in SS group had any discomfort while in SF group 40 (80%) had grade I and 10 (20%) had grade II discomfort. In SF group 40 (80%) preferred flexed posture while 10 (20%) preferred straight posture. In SS group no patient preferred flexed posture. Conclusions: Successful spinal anaesthesia is possible in patients irrespective of sitting straight or sitting flexed posture but more number of patients require second attempt with straight back. Though majority of patients preferred to sit straight, spinal anaesthesia is technically easier in patients having their back flexed during the procedure.
Article Details
References
Fettes PD, Jansson JR, Wildsmith JA. Failed spinal anaesthesia: mechanisms, management, and prevention. Br J Anaesth.2009; 102: 739-48.
Garcia AM, Marti A, Rodriguez PM, Villamor M, Martínez A, Moral MV. Predictors of difficulty in neuraxial block: A prospective study: 8AP1-6. Eur J Anaesthesiol. 2011; 28:110.
Kim JH, Song SY, Kim BJ. Predicting the difficulty in performing neuraxial blockade. Korean J Anesthesiol. 2011; 61:377-81.
Brown DL. Spinal epidural and caudal anesthesia, In: Miller Anesthesia Miller RD, Editor, 6th ed. Philadelphia (US): Elsevier Churchill Livingstone; 2005.p. 1661-4.
de Filho GR, Gomes HP, da Fonseca MH, Hoffman JC, Pederneiras SG, Garcia JH. Predictors of successful neuraxial block: a prospective study. Eur J Anaesthesiol. 2002; 19:447-51.
Bernards CM. Epidural and spinal anesthesia. In: Barash PJ, Cullen BF, Stoelting RK, Editors. Clinical Anesthesia. Philadelphia: Lipincott Raven Publishers; 2006: p. 696-8.
Prakash S. Patient position for spinal anaesthesia: Flexed-back versus straight-back. Ind J Anaesth. 2013; 57:95.
Fisher KS, Arnholt AT, Douglas ME, Vandiver SL, Nguyen H. A randomized trial of the traditional sitting position versus the hamstring stretch position for labor epidural needle placement. Anesth Analg 2009; 109:532-4.
Waindeskar V, Songir S, Batra M, Gaikwad MR, Khan MA, Dubey A. Comparison of straight versus flexed back in combined spinal epidural anesthesia for gynecological procedure. People’s Journal of Scientific Research. 2015;8:34-38.
Biswas BK, Agarwal B, Bhattarai B, Dey S, Bhattacharyya P. Straight versus flex back: does it matter in spinal anaesthesia? Ind J Anaesth. 2012; 56: 259-64.
De Oliveira GR, Gomes HP, da Fonseca MHZ, Hoffman JC, Pederneiras SG, Garcia JHS. Predictors of successful neuraxial block; a prospective study. Eur J Anaesthesiol. 2002;19:447-51.
Shankar H, Murugiah K, Rajput K. Correlation between spinous process dimensions and ease of spinal anaesthesia. Ind J Anaesth. 2012; 56:250.
Tashayod ME, Tamadon S. Spinal block in sitting position without moving the legs. Middle East J Anesthesiol. 1980; 5: 529-33.
Soltani Mohammadi S, Hassani M, Marashi SM. Comparing the squatting position and traditional sitting position for ease of spinal needle placement: a randomized clinical trial. Anesth Pain Med.2014; 4:e13969.
Soltani Mohammadi S, Piri M, Khajehnasiri A. Comparing three different modified sitting positions for ease of spinal needle insertion in patients undergoing spinal anaesthesia. Anesth Pain Med. 2017 Oct 23; 7:e55932.