Leg wrapping for the prevention of hypotension following spinal anesthesia in cesarean section

Leg wrapping for the prevention of hypotension following spinal anesthesia in cesarean section

Chutima Sangkheo, Nurses, D. of Anesthesiology, F. of Medicine, PSU.
Mayuree Vasinanukorn, Asst. Prof., D. of Anesthesiology, F. of Medicine, PSU.
Nattaporn Laekatham, D. of Anesthesiology, F. of Medicine, PSU.
Corresponding e-mail : vmayuree@ratree.psu.ac.th

Grant : Faculty of Medicine, PSU.
Published : Thai J of Anesthesiology 2000, 26(4) : 220-228
Key words : spinal anesthesia, cesarean section, hypotension, leg wrapping

Introduction : Hypotension following spinal anesthesia for cesarean section remains a common complication despite intravenous preloading fluid and the use of left uterine displacement.

Objectives : To investigate whether wrapping of the legs before spinal anesthesia for cesarean section will reduce the incidence of hypotension without complications from Esmarch bandaging.

Methods : 122 parturients, undergoing elective cesarean section under spinal anesthesia with 2.2 ml of 0.5% hyperbaric bupivacaine, were randomly allocated to leg wrapped group (gr. W, n= 61) and control group (gr. C, n=61). All parturients received intravenous lactated RingerÕs solution 2 ml/Kg/hr starting at 7.00 am, 20 ml/Kg within 10 minutes prior to spinal injection and 12 ml/Kg/hr thereafter until the end of operation. They were placed in the left uterine displacement position after spinal injection. Group W had both legs elevated to 45 degrees and wrapped with Esmarch bandages before spinal injection. Significant hypotension was treated with intravenous ephedrine in 6 mg bolus dose.

Results : The leg wrapped and the control groups were comparable with regards to demo- graphic data, baseline hemodynamic data, total intravenous fluid, estimated blood loss, total ephedrine and synthetic oxytocin (Syntocinon ā) dosage, numbers of parturients given methylergometrine maleate (Metherginā), operating time and Apgar score at 1, 5 minutes. The incidence of hypotension in group W was 52.4% while in group C was 63.9% which was not statistically different (p=0.198). The parturients in group W were less likely to have hypotension following spinal anesthesia (relative risk = 0.82, 95% confidence intervals = 0.60-1.11) than were those in group C. There were no com-plications from Esmarch bandaging and spinal anesthesia determined for 3 days postoperatively.

Conclusion : The study fails to demonstrate a statistically significant difference in the rate of hypotension following spinal anesthesia for cesarean section between parturients receiving leg wrapping and those not receiving. Furthur studies with larger sample size may be needed to examine the efficacy of leg wrapping in preventing hypotension in such condition.

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