Sevgi KUTLUSOY, Hasan DUMAN, Ebru DUMAN
Türk Geriatri Dergisi - 2026;29(3):368-378
Introduction: Spinal anesthesia-induced hypotension is a frequent and life-threatening complication in high-risk geriatric patients. Lateral decubitus positioning after hyperbaric bupivacaine injection may restrict sympathetic blockade to the operative side, preserving hemodynamic stability. This study compared hemodynamic effects of 15-minute lateral decubitus versus immediate supine positioning after spinal anesthesia in ASA III-IV geriatric patients undergoing lower extremity orthopedic surgery. Materials and Method: Seventy patients aged >=65 years (ASA III-IV) were randomized to Group L (n=35; lateral decubitus for 15 minutes, operative side down, then supine) or Group S (n=35; immediate supine). All received 12 mg of 0.5% hyperbaric bupivacaine in the sitting position. Primary outcome was hypotension incidence (MAP <65 mmHg or >=20% decrease from baseline) during the first 15 minutes. Secondary outcomes included bradycardia, vasopressor requirement, sensory block level, and peripheral oxygen saturation. Results: Baseline characteristics were comparable. Hypotension occurred in 0 patients in Group L versus 11 (31.4%) in Group S (p<0.001). Bradycardia was observed in 1 (2.9%) versus 9 (25.7%) patients (p=0.013). Maximum sensory block was lower in Group L (T9 vs. T7; p<0.001); unilateral block rates at 15 and 30 minutes were higher (71.4% and 51.4% vs. 0%; p<0.001). MAP differences were evident from minute one (108.3+/-8.6 vs. 97.9+/-17.2 mmHg; p=0.002). Peripheral oxygen saturation did not differ at any time point. Conclusion: Lateral decubitus positioning for 15 minutes after spinal anesthesia reduces hypotension and bradycardia in ASA III-IV geriatric patients without pharmacological intervention or equipment. This cost-free positional strategy may be safely integrated into routine anesthetic practice for high-risk elderly patients.
