Optimal patient positioning for spinal anesthesia using a visual aid in cesarean section patients: A randomized control trial.

Background and Aims: Spinal anesthesia is the safest technique of anesthesia in parturients for cesarean section. Usually, patients are instructed verbally to acquire the ideal position for spinal anesthesia, but there can be difficulty in attaining the best position if patients fail to understand the verbal command, which will lead to detainment in accomplishing the technique and increased possibility of patient's dissatisfaction. Hence, in our study, we hypothesized that using photographs with verbal commands would reduce the time taken for spinal needle placement, reduce the total number of skin pricks, and improve the success at the first attempt. Material and Methods: One hundred and eleven pregnant women undergoing elective cesarean section were divided into Group C (only verbal instructions were given) and Group V (visual aid and verbal instructions were given). Time taken for successful spinal needle placement was noted in seconds and summarized in terms of median and interquartile range. Number of skin punctures, intervertebral spaces attempted, and first-pass success were determined in terms of percentage. Pearson's Chi-square test was used to compare the above parameters between the two groups. Results: There was significant reduction in the time taken for spinal needle placement in Group V compared to the control group. There was significant improvement in first-pass success rate and reduction in the number of skin pricks and intervertebral spaces attempted in Group V. Conclusions: Use of visual aid with verbal commands helps in better understanding of positioning, thus improving the first-pass success significantly. It also reduces the duration for successful spinal needle placement, number of skin pricks, and intervertebral spaces attempted.