Lower Limb Compression Prevents Hypotension After Epidural in Labor Patients: A Randomized Controlled Trial [7OP

Abstract

INTRODUCTION: Approximately 30% of patients who elect to have epidural anesthesia during labor experience hypotension, potentially causing complications for both mother and fetus. We evaluated whether lower limb compression at the time of epidural would decrease maternal hypotension. METHODS: A multisite randomized controlled trial was conducted. Term, singleton parturients requesting epidural were recruited and randomized into one of three arms: control, thrombo-embolic deterrent (TED) stockings, or sequential compression device (SCD). Hospital protocol was followed for intravenous fluid hydration prior to epidural placement. Blood pressures were evaluated at 1, 5, 15, 30, 45, and 60 minutes following administration of epidural bolus. Hypotension was defined as a decrease in either systolic or diastolic blood pressure of greater than 20% from baseline, which was the average of the three blood pressures obtained prior to the epidural. Analysis was based on intention to treat. RESULTS: Data from 71 patients were analyzed: 27 controls, 21 TEDs, and 23 SCDs. Demographics were similar across groups. Hypotension occurred in 66.7% of patients in the control arm compared to 52.4% of patients in the TED arm, and 30.4% in the SCD arm (P=.038). Logistic regression controlling for clinical site, delivery method, maternal age, gestational age at delivery, and maternal BMI did not affect the results. CONCLUSION: Lower limb compression using SCDs significantly decreased the incidence of maternal hypotension in laboring patients receiving epidural anesthesia. Our incidence of maternal hypotension was higher than what is reported in the literature.