Effects Of Neuraxial Anesthesia In Sitting And Lateral Positions On Maternal Hemodynamics In Cesarean Section: A Systematic Review And Meta-Analysis

Abstract

This systematic review and meta-analysis was undertaken to evaluate the effects of maternal positioning—sitting versus lateral—during neuraxial anaesthesia on maternal haemodynamics and neonatal outcomes in caesarean section. A systematic literature review was conducted on randomised controlled trials and observational studies published between January 2010 and June 2025. Databases searched included PubMed, Cochrane Library, Scopus, and Embase. The review protocol adhered to PRISMA guidelines. Studies comparing sitting and lateral positions during spinal or combined spinal-epidural anaesthesia were included. Outcomes assessed were maternal hypotension, vasopressor requirement, heart rate changes, sensory and motor block characteristics, maximum block level, and neonatal Apgar scores. A total of five studies, encompassing 572 parturients, met the eligibility criteria. Meta-analysis was performed using random-effects models due to anticipated heterogeneity, which was evaluated using the I² statistic. The pooled analysis demonstrated a modest reduction in the incidence of maternal hypotension in the lateral group (RR 0.83, 95% CI: 0.71–0.96; p=0.01) with moderate heterogeneity (I² = 58%). Vasopressor requirement was lower but not statistically significant. Neonatal Apgar scores and other block characteristics were comparable across groups. Risk of bias was low in three studies and moderate in two. The findings suggest that the lateral position may offer a haemodynamic advantage without adversely affecting neonatal outcomes. However, given study heterogeneity and limited sample size, conclusions should be interpreted with caution. Larger, well-designed trials are recommended. This review was not registered in PROSPERO or a similar database.