Department of Anesthesiology, Osaka Women's and Children's Hospital, 840 Murodo-Cho, Izumi, Osaka, 594-1101, Japan.
Department of Anesthesiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-Cho, Kahoku-Gun, Ishikawa, 920-0293, Japan.
J Anesth. 2023 Jun;37(3):426-432. doi: 10.1007/s00540-023-03182-8. Epub 2023 Mar 21.
Generally, combined spinal-epidural anesthesia (CSEA) for labor analgesia is performed in the lateral or sitting position; however, only few studies have investigated the effect of maternal position on labor analgesia induction. We aimed to retrospectively assess the influence of maternal position on induction time and complications.
We retrospectively analyzed anesthetic and medical records regarding labor analgesia in 201 parturients treated between January 2019 and November 2019. Patients were classified into 2 groups based on their position (sitting or lateral) during induction. The primary outcome was the time required for CSEA induction. We compared 2 groups on the primary outcome and the occurrences of other complications during CSEA induction using hyperbaric bupivacaine. Moreover, we performed multiple linear regression analysis to identify independent factors associated with induction time.
There was no significant between-group difference in the time required for induction. Multiple linear regression analysis revealed an independent association of the distance from the skin to the epidural space with the time required for induction. The lateral group had a significantly higher incidence of paresthesia than the sitting group (P = 0.028). The lateral group had a significantly higher ephedrine requirement (P < 0.001) than the sitting group.
Maternal position was not associated with the time required for CSEA induction. However, the sitting group had a lower paresthesia occurrence and ephedrine requirement than the lateral group. Other technical complications were not associated with maternal position during CSEA induction.
一般来说，联合脊髓-硬膜外麻醉（CSEA）用于分娩镇痛时产妇采取侧卧位或坐位；然而，仅有少数研究调查了产妇体位对分娩镇痛诱导的影响。我们旨在回顾性评估产妇体位对诱导时间和并发症的影响。
我们回顾性分析了 2019 年 1 月至 2019 年 11 月期间接受分娩镇痛治疗的 201 名产妇的麻醉和医疗记录。根据诱导时的体位（坐位或侧卧位）将患者分为两组。主要结局是 CSEA 诱导所需的时间。我们比较了两组患者在主要结局和使用布比卡因行 CSEA 诱导时其他并发症的发生情况。此外，我们还进行了多元线性回归分析，以确定与诱导时间相关的独立因素。
两组诱导所需的时间无显著差异。多元线性回归分析显示，皮肤到硬膜外腔的距离与诱导时间独立相关。与坐位组相比，侧卧位组感觉异常的发生率明显更高（P=0.028）。与坐位组相比，侧卧位组需要更多的麻黄碱（P<0.001）。
产妇体位与 CSEA 诱导所需的时间无关。然而，与侧卧位组相比，坐位组感觉异常的发生率和麻黄碱的需求较低。在 CSEA 诱导过程中，其他技术并发症与产妇体位无关。
