Efficacy Of Different Positions For Neuraxial Anesthesia In Caesarean Section: A Meta-Analysis

Background and objectives: Positions during induction of neuraxial anesthesia are related to maternal and fetus health. The aim of our analysis was to evaluate whether lateral position could make more benefit than oxford and sitting positions to both anesthesia and physical conditions of parturients and neonatus. Methods: The Pubmed, the Cochrane Library and Embase database was searched for relevant studies. The Cochrane collaboration's tool for assessing risk of bias was used to assess quality of studies. Review manager and Stata were used for statistical analysis. Results: Thirteen randomized controlled trails with 702 participants were included. Lateral position was more effective on anesthesia effect compared with sitting (mean difference (MD)=-2.02, 95% confidence interval (CI): -3.38 to -0.67) and oxford position (MD=-5.36, 95% CI: -6.58 to -4.14), respectively. Sitting position had higher hypotension incidence than lateral position (odds ratio (OR)=0.53, 95% CI: 0.26 to 1.05). Ephedrine consumption among groups represented obvious heterogeneity and a conclusion could not be drawn. Result of combined side effects including nausea and vomiting and shivering was consistent with anesthesia effect between lateral and sitting positions (OR=1.59, 95% CI: 1.03 to 2.45). Neonatal status showed no significant differences among different positions. Conclusions: This study suggested that lateral position might be more beneficial to parturients and neonatus in more adequate anesthesia and lower complication incidence. Potential hemodynamics fluctuation affected by positions needed further disclosure. Positions during induction of neuraxial anesthesia may not influence neonatal status.