Evaluation of hemodynamic changes after leg wrapping in elective cesarean section under spinal anesthesia

Abstract

Background: Spinal block provides excellent anesthesia for cesarean section, but it is frequently accompanied by hypotension, which if untreated can pose serious risks to mother and baby. Over the years, many interventions have been tried to prevent hypotension, but no single technique has proven to be effective and reliable. This study was carried out with the aim to find if wrapping the legs with elastic crepe bandage in addition to traditional methods was effective in preventing post spinal hypotension. Materials and Methods: A total of 60 full-term parturients with an uncomplicated pregnancy belonging to American Society of Anesthesiologists I or II were allocated randomly (30 in each group) to have their legs wrapped with elastic crepe bandage or no wrapping was done. All patients received intravenous (IV) crystalloid (20 ml/kg) 15 min prior to spinal injection and were placed in left lateral position. Electrocardiography and oxygen saturation was monitored continuously and heart rate, blood pressure was measured every 2 min until delivery of baby and every 5 min thereafter until end of cesarean section. Significant hypotension was treated with IV phenylephrine 50 µg bolus doses. Results: The frequency of hypotension was significantly less (P = 0.009) in Group B (legs wrapped group) 3 (10%) patients when compared with Group A (nonleg wrapped) 13 (43.33%). In Group A 10 (33.33%) patients and in Group B 3 (10%) patients required rescue dose with phenylephrine which was statistically significant (P = 0.0003). Difference in the "mean change of arterial pressure" between Group A and B was highly significant (P < 0.001) recorded at 4, 6, and 8 min. Conclusion: Incidence of hypotension can be reduced by wrapping the legs with elastic crepe bandage with a subsequent reduction in the use of potent vasopressor. Since leg wrapping with crepe bandage is cheap, easy, readily available, noninvasive, and nonpharmacological method, it can be recommended for preventing post spinal hypotension in a developing country like ours.

Keywords

• Caesarean section
• leg wrapping
• spinal anaesthesia