Leg elevation decreases the incidence of post-spinal hypotension in cesarean section: a randomized controlled trial

Ahmed Hasanin, Ahmed Aiyad, Ahmed Elsakka, Atef Kamel, Reham Fouad, Mohamed Osman, Ali Mokhtar, Sherin Refaat, Yasmin Hassabelnaby, Ahmed Hasanin, Ahmed Aiyad, Ahmed Elsakka, Atef Kamel, Reham Fouad, Mohamed Osman, Ali Mokhtar, Sherin Refaat, Yasmin Hassabelnaby

Abstract

Background: Maternal 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.

Methods: One 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.

Results: LE 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).

Conclusion: LE performed immediately after spinal block reduced the incidence of PSH in parturients undergoing CS.

Trial registration: The study was registered at Pan African Clinical Trials Registry system on 5/10/2015 with trial number PACTR201510001295348 .

Keywords: Cesarean section; Hypotension; Leg elevation; Spinal anesthesia.

Figures

Fig. 1
Fig. 1
Flow chart for patient enrolment. LE: Leg elevation
Fig. 2
Fig. 2
Systolic and diastolic blood pressure. Data are means, error bars are standard deviations. LE: Leg elevation. *denotes statistical significance between the two groups
Fig. 3
Fig. 3
Heart rate. Data are means, error bars are standard deviations. LE: Leg elevation

References

    1. Mercier FJ, Augè M, Hoffmann C, Fischer C, Le Gouez A. Maternal hypotension during spinal anesthesia for caesarean delivery. Minerva Anestesiol. 2013;79(Suppl 1):62–73.
    1. Loubert C. Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: continuing professional development. Can J Anaesth. 2012;59(Suppl 6):604–19. doi: 10.1007/s12630-012-9705-9.
    1. Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006;(4):CD002251.
    1. Cluver C, Novikova N, Hofmeyr GJ, Hall DR. Maternal position during caesarean section for preventing maternal and neonatal complications. Cochrane Database Syst Rev. 2010;(6):CD007623.
    1. Caille V, Jabot J, Belliard G, Charron C, Jardin F, Vieillard-Baron A. Hemodynamic effects of passive leg raising: an echocardiographic study in patients with shock. Intensive Care Med. 2008;34(Suppl 7):1239–45. doi: 10.1007/s00134-008-1067-y.
    1. Monnet X, Teboul J-L. Passive leg raising. Intensive Care Med. 2008;34(Suppl 4):659–63. doi: 10.1007/s00134-008-0994-y.
    1. Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006;34(Suppl 5):1402–7. doi: 10.1097/01.CCM.0000215453.11735.06.
    1. Rutlen DL, Wackers FJ, Zaret BL. Radionuclide assessment of peripheral intravascular capacity: a technique to measure intravascular volume changes in the capacitance circulation in man. Circulation. 1981;64(Suppl 1):146–52. doi: 10.1161/01.CIR.64.1.146.
    1. Rout CC, Rocke DA, Gouws E. Leg elevation and wrapping in the prevention of hypotension following spinal anaesthesia for elective caesarean section. Anaesthesia. 1993;48(Suppl 4):304–8. doi: 10.1111/j.1365-2044.1993.tb06948.x.
    1. Meirowitz N, Katz A, Danzer B, Siegenfeld R. Can the passive leg raise test predict spinal hypotension during cesarean delivery? An observational pilot study. Int J Obstet Anesth. 2012;21(4):324–8. doi: 10.1016/j.ijoa.2012.08.004.
    1. Morgan PJ, Halpern SH, Tarshis J. The effects of an increase of central blood volume before spinal anesthesia for cesarean delivery: a qualitative systematic review. Anesth Analg. 2001;92(Suppl 4):997–1005. doi: 10.1097/00000539-200104000-00036.
    1. Køhler F, Sørensen JF, Helbo-Hansen HS. Effect of delayed supine positioning after induction of spinal anaesthesia for caesarean section. Acta Anaesthesiol Scand. 2002;46(Suppl 4):441–6. doi: 10.1034/j.1399-6576.2002.460419.x.
    1. Obasuyi BI, Fyneface-Ogan S, Mato CN. A comparison of the haemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for caesarean section. Int J Obstet Anesth. 2013;22(Suppl 2):124–8. doi: 10.1016/j.ijoa.2012.12.005.
    1. Quan Z, He H, Tian M, Chi P, Li X. Influence of lateral decubitus positioning after combined use of hyperbaric and hypobaric ropivacaine on hemodynamic characteristics in spinal anesthesia for caesarean section. Int J Clin Exp Med. 2014;7(Suppl 12):5669–74.
    1. Mercier FJ. Fluid loading for cesarean delivery under spinal anesthesia: have we studied all the options? Anesth Analg. 2011;113(Suppl 4):677–80. doi: 10.1213/ANE.0b013e3182245af4.
    1. Mercier FJ, Diemunsch P, Ducloy-Bouthors A-S, Mignon A, Fischler M, Malinovsky J-M, et al. 6% Hydroxyethyl starch (130/0.4) vs Ringer’s lactate preloading before spinal anaesthesia for Caesarean delivery: the randomized, double-blind, multicentre CAESAR trial. Br J Anaesth. 2014;113(Suppl 3):459–67. doi: 10.1093/bja/aeu103.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj