Effect of a 1-Min Sitting Period after Intrathecal Hyperbaric Ropivacaine on Hemodynamic Stability during Lower-Limb Orthopedic Surgery: A Randomized Controlled Trial
Swathi Kamath, Murali Shankar Bhat, Anirudh Panemangalore PaiAbstract
Background:
Position after intrathecal injection can influence the spread of hyperbaric local anesthetic and the resulting sympathetic blockade. We evaluated whether remaining seated for 1 min after intrathecal administration of 0.75% hyperbaric ropivacaine improved hemodynamic stability compared with immediate supination.
Materials and Methods:
In this observer-blinded randomized trial, 74 patients aged 18–60 years with American Society of Anesthesiologists physical status I–II undergoing lower-limb orthopedic surgery were allocated equally to the immediate supination (Group A) or remaining seated for 1 min before supination (Group B) groups. All patients received 3 mL (22.5 mg) of 0.75% hyperbaric ropivacaine. Serial hemodynamic measurements, block characteristics, analgesia duration, vasopressor requirements, and adverse events were assessed.
Results:
All 74 patients completed the trial. Significant group-by-time interactions were observed for heart rate and mean arterial pressure (both
Conclusions:
A 1-min sitting period after intrathecal hyperbaric ropivacaine was associated with greater early hemodynamic stability and fewer overall complications but delayed sensory-block onset and shortened motor-block and analgesia durations. Larger multicenter trials are needed to confirm these findings.