Role of Patient Positioning in Reducing Post-Spinal Hypotension During Surgery

Abstract

Background: Post-spinal hypotension is a significant complication of spinal anesthesia, driven by sympathetic blockade and reduced venous return, posing substantial risks to vulnerable surgical populations. While pharmacological management remains central, non-pharmacological strategies such as patient positioning have been proposed to mitigate hypotensive events by influencing hemodynamic stability. Objective: This study aimed to evaluate the role of different surgical positions—lateral, sitting, supine, and Trendelenburg—in reducing the incidence of post-spinal hypotension and to explore associated patient and perioperative variables. Methods: A retrospective descriptive cross-sectional analysis was conducted on 300 adult patients undergoing elective surgery under spinal anesthesia across four hospitals in Lahore, Pakistan, over six months. Data included patient demographics, surgical details, intraoperative blood loss, fluid administration, and incidence of hypotension, analyzed using chi-square tests and odds ratios with IBM SPSS software, with significance set at p < 0.05. Results: The incidence of hypotension was 38.2% in lateral, 45.5% in sitting, 39.2% in supine, and 44.4% in Trendelenburg positions, with no statistically significant association between surgical position and hypotension (p = 0.750). Demographic and perioperative parameters showed minimal intergroup differences. Conclusion: While the lateral position exhibited the lowest hypotension rate, surgical positioning alone did not significantly influence post-spinal hypotension, highlighting the necessity for comprehensive management strategies and individualized patient care, warranting further prospective studies.