Sir,

Trendelenberg position with hip flexion is an important rescue strategy to increase spinal anaesthetic level after spinal block. We would like to share our experience regarding the same. We have been routinely doing this maneuver in patients undergoing caesarean section and in geriatric patients where we find it very effective. In our practice when the desired spinal block is not achieved we flex the hip and knee and bring the thighs over the abdomen and have observed that with this maneuver the level of block improves at least by 2-3 segments.¹

This is of great importance especially for patients undergoing caesarean
section under spinal anaesthesia where small volume of local anaesthetic is used. Here we
are careful that the thighs do not compress the abdomen. In some patients we put the
patient in a hip flexion and raise the upper thoracic spine with pillow support to avoid a
higher spinal block level that may lead to higher incidence of hypotension and
bradycardia. Use of narcotics along with LA for spinal block in patients undergoing
caesarean section is advocated to minimize the dose of LA thus avoiding hypotension
associated with spinal block, but in developing country like ours where narcotics like
fentanyl, sufentanil, etc are not easily available, hip flexion maneuver is very useful
.

Further prospective studies can be taken up with defined angle of
flexion at the hip and angle of trendelenberg position to achieve best spinal block level
with minimal haemodynamic effects .