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{"references": ["1. Brown DL. Spinal epidural and caudal anesthesia, Miller Anesthesia, In: Miller RD, Editor, 6 th ed. Philadelphia (US): Elsevier Churchill Livingstone; 2005.p. 1661-4.", "2. Bernards CM. Epidural and spinal anesthesia, Clinical Anesthesia, In: Barash PG, Cullen BF, Stoelting RK, Editors. 5th ed. Philadelphia: Lipincott-Raven Publishers; 2006.p. 696-98.", "3. Fisher A, Lupu L, Gurevitz B, Brill E, Margolin E, Hertzanu Y. Hip flexion and lumbar puncture: A radiological study. Anaesthesia 2001;56:262-66.", "4. Sandoval M, Shestak W, Sturmann K, Hsu C. Optimal patient position for lumbar puncture, measured by ultrasonography. Emerg Radiol 2004; 4:179-71.", "5. Platt F, Hall M. Hip flexion for lumbar puncture-not easy for obstetric practice. Anesthesia 2001;56:1023.", "6. Schelew BL, Vaghadia H. Ankylosing Spodylitis and neuroaxial anesthesia: A 10 year review. Can J Anaesth 1996;43:55-8.", "7. DeOliveira GR, Gomes HP, da Fonseca MH, Hoffman JC, Pederneiras SG, Garcia JH. Predictors of successful neuroaxial block; a prospective study. Eur J Anaesthesiol 2002;19:447-41", "8. Tarkkila P, Huhtala J, Salminen U. Difficulties in spinal needle use: Insertion characteristics and failure rates associated with 25-, 27-and 29-gauge Quincke-type spinal needles. Anesth 1994;49:723-25", "9. Kokki H, Hendolin H. Comparison of 25 G and 29G Quincke spinal needles in paediatric day case surgery: A prospective randomized study of the puncture characteristics, success rate and post operative complaints. Pediatric Anaesth 1996;6:115-19.", "10. Biswas BK, Agarwal B, Bhattarai B, Dey S, Bhattacharyya P. Straight versus flex back: Does it matter in spinal anesthesia?. Indian J Anaesth 2012;56:259-54.", "11. Platt F, Hall M. Hip flexion for lumbar puncture-not easy for obstetric practice. Anesthesia 2001;56:1023.", "12. Yun EM, Marx GF, Santos AC. The effects of maternal position during induction of combined spinal-epidural anesthesia for cesarean delivery. Anesth Analg 1998;87:614-18.", "13. Yun EM, Marx GF, Santos AC. The effects of maternal position during induction of combined spinal-epidural anesthesia for cesarean delivery. Anesth Analg 1998;87:614-18."]}
The success of subarachnoid or epidural anesthesia is influenced by the quality of patient’s anatomical landmarks, the adequacy of patient positioning, and the provider’s level of experience. Incorrect posture resulting in multiple attempts, cause patient discomfort (thus rendering the technique unpleasant to the patient), post-dural puncture headache, and trauma to neural structures. Indeed, there are patients who are unable to adopt the ideal flexed posture due to arthritis, spondylosis, or pain due to limb trauma. It may be uncomfortable for some patients to assume a flexed posture. Hence, we worked on the above issues to determine the patient’s preferred posture and success of block performed in flexed posture and straight posture. Effect on hemodynamic parameters, attempts required, number of patients requiring manipulation of needle, number of patients requiring epidural supplementation. CSEA can be performed with equal ease in a seated patient regardless of the posture of the back being in a flexed or in a straight posture. CSEA block combines the rapidity, density and reliability of spinal block with the ability of continuous epidural to extend the duration of analgesia. It has been used in thousands of patients without any reports of major problems.
position, sitting straight, combined spinal-epidural, anesthesia, sitting flexed
position, sitting straight, combined spinal-epidural, anesthesia, sitting flexed
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