Comparison of the level of sensory blockade achieved when spinal anaesthesia is performed for caesarean section before and after urinary bladder catheterisation: a randomised controlled study

Background:  Spinal anaesthesia has a prominent place in obstetric anaesthesia. Factors affecting the sensory level and the depth of anaesthesia and associated complications have been topics for much discussion. One such topic is whether keeping the patient supine for bladder catheterisation after the spinal injection would enhance spread of the anaesthetic agents upwards in the subarachnoid space leading to grave complications. Objectives: To observe whether there was a clinically significant difference in the sensory levels achieved, changes in blood pressure and pulse rates when bladder catheterization was done before as opposed to  after spinal anaesthesia, for caesarean section.  . Method: 106 pregnant women undergoing cesarean section were randomised into two groups, with one group receiving spinal anaesthesia before bladder catheterisation and the other receiving spinal anaesthesia after catheterisation. Results: The initial sensory level of T4 was achieved by 76% and 53.4% women who were catheterized before and after spinal anaesthesia respectively. The systolic and diastolic blood pressure dropped, and the pulse rate increased in both groups. There was no significant difference in either the spinal sensory level achieved, or the blood pressure and pulse rate changes observed whether the bladder was catheterized before or after spinal anaesthesia. Conclusions: There was no difference in either the spinal sensory level achieved or the haemodynamic changes irrespective of whether the bladder was catheterized before or after spinal anaesthesia.