Trendelenburg position with hip flexion as a rescue strategy to increase spinal anaesthetic level after spinal block

Abstract

Background: When the level achieved by a spinal anaesthetic is too low to perform surgery, patients are usually placed in the Trendelenburg position. However, cephalad spread of the hyperbaric spinal anaesthetics may be limited by the lumbar lordosis. The Trendelenburg position with the lumbar lordosis flattened by hip flexion was evaluated as a method to extend the analgesic level after the administration of hyperbaric local anaesthetic.

Methods: When the pinprick block level was lower than T10 5 min after intrathecal injection of hyperbaric bupivacaine (13 mg), patients were recruited to the study and randomly allocated to one of the two positions: the Trendelenburg position with hip flexion (hip flexion group, n = 20) and the Trendelenburg position without hip flexion (control group, n = 20). Each assigned position was maintained for 5 min and then patients were returned to the horizontal supine position. Spinal block level was assessed by pinprick, cold sensation, and modified Bromage scale at intervals for the following 150 min.

Results: The maximum level of pinprick and cold sensory block [median (range)] was higher in the hip flexion group [T4 (T8-C6) and T3 (T6-C2)] compared with the control group [T7 (T12-T4) and T5 (T11-T3)] (P < 0.001). The maximum motor blockade median (range) was not different between the two groups being 3 (3-3) in the hip flexion group vs 3 (0-3) in the control group.

Conclusions: When the level of spinal anaesthesia is lower than required, flexion of the hips in the Trendelenburg position may be useful as a strategy attempt to increase the level of the block.