Comparison of hamstring stretch position with modified rider sitting position on patient comfort in patients with fracture around the knee undergoing spinal anaesthesia – a randomized crossover trial

<title>Abstract</title> <p>Background: Patient positioning plays a crucial role in the success of spinal anaesthesia by influencing both patient comfort and ease of identifying anatomical landmarks. In patients with fractures around the knee, pain and restricted mobility makes positioning challenging, necessitating techniques that minimize discomfort while ensuring adequate access to the interspinous space. Objectives: To compare patient’s comfort between hamstring stretch position and modified rider sitting position during spinal anaesthesia and to compare anaesthesiologist’s ease in finding interspinous space in both hamstring stretch position and modified rider sitting position. Methods: This prospective randomized crossover study included 94 adult patients undergoing surgery under spinal anaesthesia for fractures around the knee. Each participant was evaluated in both HSP and mRSP. Patient comfort was assessed using the Numerical Rating Scale (NRS), and the ease of interspinous space identification was graded using the Spinal Landmark Grading System (SLGS). Data were analyzed using JAMOVI software (version 2.5.3) and SPSS version 29. Paired t-test was used to compare differences in pain scores between HSP and mRSP. Wilcoxon signed rank test was used to compare the ease of ISS identification between the two positions. Results:94 participants were recruited in this study. Pain was consistently lower in the mRSP (mean NRS: 5), when compared to the HSP (mean NRS: 4) (mean difference=0.99±1.3, 95% confidence interval (CI): 0.7 to 1.3; p&lt;0.001). Spinal landmark grading demonstrated a clear shift toward easier identification in mRSP than HSP position. Conclusion:The modified Rider Sitting Position produces lesser procedural pain and discomfort for patients with fractures around the knee being positioned for spinal anaesthesia as compared to the Hamstring Stretch Position without compromising the anaesthetist’s ability to locate interspinous space landmarks. Trial registration:This trial was registered with Clinical Trials Registry India registration (CTRI/2025/07/091336) on July 21, 2025.</p>