Evaluation of Hemodynamic changes 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.