Is Straight Back a Good Alternative to the Flexed Back for Spinal Anaesthesia?

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Udit Girdhar
Pallavi Sangwan
Ranjeet Singh
Kshitij Yadhav
Shikha Gupta
Baljit Singh


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.

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Udit Girdhar, Pallavi Sangwan, Ranjeet Singh, Kshitij Yadhav, Shikha Gupta, & Baljit Singh. (2023). Is Straight Back a Good Alternative to the Flexed Back for Spinal Anaesthesia?. Journal of Coastal Life Medicine, 11(1), 3165–3172. Retrieved from


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