Comparison of spinal anesthesia at L3-L4 versus L4-L5 in obstetric patients undergoing Cesarean section at South east hospital and research center.

Abstract

Objective: To compare the efficacy and safety of spinal anesthesia at the L3-L4 versus L4-L5 intervertebral spaces in obstetric patients undergoing elective C-sections. Study Design: Prospective, Randomized Controlled Trial. Setting: South East Hospital and Research Center Islamabad. Period: January 2023 to December 2023. Methods: Included the patients who were scheduled for elective C-sections. The main outcomes included the onset and the duration of sensory block, the degree of sensory blockade achieved, intraoperative hemodynamics, control of postoperative pain, satisfaction of mothers. Results: The results indicate that lumbar spinal anesthesia at L3-L4 given to patient results in quicker sensory block when compared to L4-L5 (L3-L4, 65% within 5 mins. Vs. L4-L5, 3.4%) while the effective duration of L4-L5 group was longer (87% between 2 – 2.5 hrs). In addition to this, L3-L4 spinal block achieved a higher level (T4) of sensory block compared to L4-L5 which recorded a lower incidence of hypotension with the L3-L4 group experiencing hypotension at 61.7% compared to only 2% in the L4-L5 group. Conclusion: This study indicates that higher levels of the spinal anaesthsia can be attained quicker with the L3-L4 approach but better and longer analgesia is achieved with the L4-L5 level and without compromising hemodynamic stability. This information will be important to the clinicians in determining the best spinal anesthetic level for elective and emergency Cesarean section surgeries enhancing safety of the patients and improving the results.