Incidence of Maternal Hypotension under Spinal Anesthesia using Right Lumbar Wedge Compared to Supine Position during Cesarean Section
Jedsadayoot Sakaroonchai MD*, Phark Thanphraisan MD*, Parichat Curry MD*
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathumthani, Thailand
Objective : Left uterine displacement with right lumbar wedge has been used to decrease incidence and severity of maternal
hypotension and to improve neonatal outcome. However, a recent systematic review shows no clear evidence of benefit. The
aim of the study was to evaluate the role of using a right lumbar wedge after spinal anesthesia in the incidence of perioperative
maternal hypotension during cesarean delivery.
Material and Method: Two hundred healthy women undergoing elective cesarean section were randomly allocated immediately
after spinal block to either a 15 degree of right lumbar-pelvic wedge position (Wedge group, n = 100) or supine position
(Supine group, n = 100). Hemodynamic values, vasopressor requirements, neonatal APGAR score and umbilical blood pH
were collected.
Results : The incidences of hypotension were similar (81.63% in Wedge group vs. 79.17% in Supine group, p = 0.856). There
were no differences in the lowest systolic and mean blood pressure, intraoperative fluid, vasopressor requirements, neonatal
APGAR score and umbilical blood pH.
Conclusion : The use of a fifteen-degree right lumbar-pelvic wedge, when compared to complete supine position, was not
effective in reducing the incidence of hypotension in spinal anesthesia for cesarean delivery.
Keywords : Left uterine displacement, Right lumbar wedge, Cesarean section, Spinal anesthesia, Hypotension
