Comparing the Ease of Inducing Spinal Anaesthesia in the Sitting Position in Trauma Patients with the Hip Flexed Versus Non Flexed (Hamstring Position)

Abstract

Background: Sitting position is the favoured for spinal anaesthesia position because identification of midline structures is easier. It is either in the flexed hip or the non flexed hip (hamstring) position.  Traditionally spinal anaesthesia has been induced in the flexed hip position, and this has been supported by radiological evidence. Trauma patients who are unable to assume this position can use an alternative hamstring position. This study compared the ease of establishing spinal anaesthesia in the flexed versus non flexed hip positions.

Materials and Method: 84 patients were recruited after meeting the inclusion criteria. Two groups of 42 patients each, either sitting with foot placed on a stool (SF) to cause hip flexion and a second group (ST) sitting with leg placed on the operating table in the non flexed hip (hamstring) position. Under strict asepsis, spinal anaesthesia was established at a preferred intervertebral space (L2-L5), proportion of first attempt success, number of attempts, number of redirections, duration taken to establish spinal, complication were compared.

Results: There were no statistical differences between the two groups in relation to first attempt  success (p value 0.56), number of second attempts and re-directions, (p value 0.31), time to establish spinal (p value 0.365), incidence of complication like Paresthesia, back ache (p value 0.68).

Conclusion: There is no difference in the ease of performing spinal in either the flexed hip or the hamstring position; the goal of Spinal anaesthesia should be that patient is induced in optimal position to reduce patient discomfort and number of attempt.

Key words: Spinal Technique, Flexed Hip, Non Flexed Hip, Trauma Patient, Outcome.