Open Access Surgery (Oct 2023)
Effectiveness of Leg-Elevation to Prevent Post-Spinal Hypotension in Elective Cesarean Section: A Systematic Literature Review of Randomized Controlled Trial
Abstract
Aschalew Besha Desta,1 Belete Alemu,1 Addisu Mossie,1 Minda Abebe,1 Adanech Shiferaw,1 Bizuwork Girma,2 Tajera Tageza Ilala,1 Kidanamariam Tamrat Yilma,1 Khalid Mohamed3 1Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia; 2Department of Anesthesia, College of Health Sciences and Medicine, Selale University, Fiche, Ethiopia; 3Department of Anesthesia, College of Health Sciences and Medicine, Bule Hora University, Bule Hora, EthiopiaCorrespondence: Aschalew Besha Desta, Anesthesia Department, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia, Email [email protected]: A typical side effect of spinal anaesthesia is post-spinal hypotension. Its overall incidence ranges between 25– 75% in the general population, and it is even higher in pregnant mothers who underwent a caesarean delivery. Post-spinal hypotension-related adverse effects can be prevented by having adequate evidence-based knowledge about their management and prevention. The objective of this review is to determine the effectiveness of leg elevation in preventing post-spinal induced hypotension during elective caesarean sections.Methods: A comprehensive literature search was conducted in PubMed, the Medline database, the Cochrane Review, and Google Scholar from 1993 to 2023. Healthy women with full-term pregnancies who underwent elective caesarean delivery performed with spinal anaesthesia were included, and parturients with co-existing diseases, studies on other population, case reports studies written in non-English languages and studies contain abstract only were excluded. For both interventional and non-interventional research, the methodological strengths of the included studies were evaluated using the Cochrane risk of bias assessment tool.Results: A total of 8158 articles from various electronic databases were found using the search method. After removing duplicates, 247 articles were chosen for screening; 13 were included for critical evaluation, and 6 were eliminated with justifications. The included publications are made up of 7 RCTs on 681 pregnant women in 5 different countries, and it was found that the leg elevated group had a lower incidence of post-spinal hypotension than the control group.Conclusion: A majority of the evidence revealed that leg elevation following spinal anaesthesia in a caesarean delivery was effective in preventing post-spinal-induced hypotension. In addition to prevention, applying leg elevation following spinal anaesthesia is helpful in lowering the incidence of post-spinal hypotension, which is catastrophic. It reduces the requirement for vasopressors and also provides a non-invasive and reversible technique that does not call for any special equipment.Keywords: leg elevation, prevention, hypotension, spinal anesthesia, cesarean section
