Abstract
BackgroundMaternal hypotension is a common complication after spinal anesthesia for cesarean section (CS). In this study we investigated the role of leg elevation (LE) as a method for prevention of post-spinal hypotension (PSH) for cesarean section.MethodsOne hundred and fifty full term parturients scheduled for CS were included in the study. Patients were randomized into two groups: Group LE (leg elevation group, n = 75) and group C (Control group, n = 75). Spinal block was performed in sitting position after administration of 10 mL/Kg Ringer’s lactate as fluid preload. After successful intrathecal injection of local anesthetic, Patients were positioned in the supine position. Leg elevation was performed for LE group directly after spinal anesthesia and maintained till skin incision. Intraoperative hemodynamic parameters (Arterial blood pressure and heart rate), intra-operative ephedrine consumption, incidence of PSH, and incidence of nausea and vomiting were reported.ResultsLE group showed lower incidence of PSH (34.7% Vs 58.7%, P = 0.005) compared to the control group. Arterial blood pressure was higher in the LE group compared to the control group in the first two readings after spinal block. Other readings showed comparable arterial blood pressure and heart rate values between both study groups; however, LE showed less ephedrine consumption (4.9 ± 7.8 mg Vs 10 ± 11 mg, P = 0.001).ConclusionLE performed immediately after spinal block reduced the incidence of PSH in parturients undergoing CS.Trial registrationThe study was registered at Pan African Clinical Trials Registry system on 5/10/2015 with trial number PACTR201510001295348.
Highlights
Maternal hypotension is a common complication after spinal anesthesia for cesarean section (CS)
We investigated the efficacy of leg elevation (LE) performed after spinal block in prophylaxis of post-spinal hypotension (PSH) during CS
Our primary outcome was incidence of PSH
Summary
This randomized controlled study was conducted at Cairo university hospitals after institutional research committee approval (N-47-2015). Our primary outcome was incidence of PSH (defined as the percent of parturients who showed at least one episode of hypotension during the period starting from spinal block till delivery of the fetus). Secondary outcome parameters included the incidence of bradycardia (defined as the percent of parturients who showed at least one episode of bradycardia during the period starting from spinal block till delivery of the fetus), total ephedrine requirements, number of hypotensive episodes, urine output, and blood loss. There was a significant decrease in systolic and diastolic blood pressure readings in both study and control groups after spinal block compared to the baseline values. LE group showed higher systolic and diastolic blood pressures compared to the control group after 1 min and 2 min from spinal block (Fig. 2). There was no significant difference between both groups regarding heart rate, blood loss, urine output, intraoperative and postoperative nausea and vomiting (Table 1; Fig. 3)
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