Is Oxford Position Better to Prevent Undesirable Higher Blockade and to Maintain Haemodynamic Stability in Subarachnoid Block for LSCS UC05-UC08
K.S. Hegde Medical Academy, Mangalore, Karnataka, India.
Introduction: The conventional positioning technique has higher incidence of the unpredictability of block height and haemodynamic instability during and after subarachnoid block in caesarean section. In ‘Oxford’ position, the woman is placed left lateral with two pillows under the shoulder and three pillows supporting the head. Following spinal injection, the woman is turned to supine position with pillows in-situ in order to minimise aorto-caval compression, which also expected to prevent higher blockade and minimise the hypotension.
Aim: To determine whether Oxford position during spinal anaesthesia produces adequate sensory and motor block height while maintaining haemodynamic stability for caesarean section.
Materials and Methods: Hundred parturients aged 18-45 years (ASA I and II) undergoing caesarean section were enrolled in this study, after obtaining written informed consent and institutional ethical clearance. Subarachnoid block was performed in the conventional left lateral position (Group L, n=50) and the Oxford position (Group O, n=50). Intrathecal injection of 2.5 mL of bupivacaine hyperbaric 0.5% was given with 25G QB spinal needle, and the parturient was positioned supine in group L (left lateral position) and with pillows in situ in group O (Oxford Position) after the subarachnoid block. Injection ephedrine 6 mg were given intravenously to maintain the Systolic Blood Pressure (SBP) >100 mmHg. Intraoperative haemodynamic parameters, the sensory and motor blockade level and time to reach T6 dermatome were monitored. The univariate analysis was done for anthropometric measurements and vitals which are shown using frequency, percentages, mean and standard deviation. Independent t-test was used to find the difference in between mean. The p-value <0.05 was taken as significant.
Results: The incidence of hypotension was more in the conventional left lateral position. Time to reach T6 dermatome was minimum in the left lateral position (5.57±0.821 min versus 9.52±1.56 min in the Oxford position p<0.0001).
Conclusion: Oxford position maintains better haemodynamic stability after subarachnoid block for ceasarean section compared to conventional position.