Abstract
Background Postspinal hypotension is the most common complication after spinal anesthesia for cesarean section (CS). Hypotension mainly occurs due to the reductions of vascular tone leading to decreased systemic vascular resistance and decreased venous return. The aim of this study was to assess the effectiveness of leg elevation (LE) as a method of prevention of postspinal hypotension in patients who undergo cesarean section under spinal anesthesia. Methods This is a single-center parallel-randomized controlled trial study, and 52 full-term parturients scheduled for elective cesarean section who meets inclusion criteria were included in the study. The randomization sequence was created by a researcher not participating in patient management using a computer random generator. The participant was randomly assigned to the leg elevation group (n = 26) or to the control group (n = 26) of usual perioperative care. Results The proportions of patients who develop hypotension are lower (8 (33.3%)) in the leg elevation group than the control group (15 (62.5%)) with an X2 (1, N = 48) = 4.09, P=0.043. The relative risk of developing postspinal hypotension in the leg elevation group compared to the control group was 0.47 (95% CI, 0.28–1.00). The proportion of severe hypotension was significantly decreased in the leg elevation group at a P value of 0.02. Conclusion Performing leg elevation immediately after spinal anesthesia reduced the incidence of hypotension. The trial is registered with PACTR201908713181850.
Highlights
Postspinal hypotension is the most common complication after spinal anesthesia for cesarean section (CS)
Results. e proportions of patients who develop hypotension are lower (8 (33.3%)) in the leg elevation group than the control group (15 (62.5%)) with an X2 (1, N 48) 4.09, P 0.043. e relative risk of developing postspinal hypotension in the leg elevation group compared to the control group was 0.47. e proportion of severe hypotension was significantly decreased in the leg elevation group at a P value of 0.02
Our study shows that the incidence of hypotension after spinal anesthesia was significantly lowered in the leg elevation group 33.3% compared to control 62.5%. e findings likely reflect the effect of augmentation in venous return due to leg elevation, which may lead to increased stroke volume and cardiac output
Summary
E incidence of hypotension during spinal anesthesia for cesarean section is reduced by administering intravenous fluids and vasopressors such as ephedrine, phenylephrine, norepinephrine, and mechanical technique such as leg compression and elevation mainly by increasing vascular tone and venous return None of this single management protocol prevents the occurrence of hypotension [2, 6, 7]. The common clinical practice for prevention of spinal hypotension is by using a combination of different management protocols such as crystalloid coload and vasopressor administration before and during the procedure Even though this is an effective method regarding to ensure maternal and fetal safety, it is not cost-effective and affordable in a resource-limited environment. Is study aims to assess the efficacy of leg elevation (LE) as a method of prevention of postspinal hypotension in patients who undergo elective cesarean section under spinal anesthesia
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