Effectiveness of Leg-Elevation to Prevent Post-Spinal Hypotension in Elective Cesarean Section: A Systematic Literature Review of Randomized Controlled Trial

Abstract

Background

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

Abbreviations

CS, Cesarean section; PSH, Post- Spinal Hypotension; LE, Leg Elevation; LR, Leg Raise; RCT, Randomized Controlled Trial; SA, Spinal Anesthesia; PRISMA, Preferred Reporting of Systematic Review and Meta-Analysis; ROBINS, Risk of Bias in non-randomized studies.

Disclosure

The authors report no conflicts of interest in this work.