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Wrapping of the legs versus phenylephrine for reducing hypotension in parturients having epidural anaesthesia for caesarean section: a prospective, randomized and double-blind study.

Author(s): Bjornestad E, Iversen OE, Raeder J

Affiliation(s): Department of Anaesthesiology and Intensive Care, Norway. elbj@helse-bergen.no

Publication date & source: 2009-10, Eur J Anaesthesiol., 26(10):842-6.

Publication type: Comparative Study; Randomized Controlled Trial

BACKGROUND AND OBJECTIVE: Wrapping of the legs significantly reduces hypotension during regional anaesthesia for caesarean sections. However, most obstetric anaesthetists prefer to use vasoconstrictors for reducing hypotension. We, therefore, compared the haemodynamic effects of wrapping the legs with prophylactic, repeated doses of intravenous phenylephrine in parturients having epidural anaesthesia for elective caesarean sections. METHOD: Forty nonlabouring women, ASA physical status I or II, were randomized either to have their legs wrapped with tight elastic bandage before initiating the epidural block (leg wrapping group) plus placebo intravenous (i.v.) injections, or to receive repeated phenylephrine boluses of 50 microg immediately and at 5 and 10 min after the epidural block (phenylephrine group) combined with a loose placebo wrapping. All parturients received 500 ml of crystalloid before and after initiation of the epidural block. Hypotension, defined as a 30% decrease from initial systolic arterial pressure (SAP) or SAP lower than 90 mmHg, was treated with 5 mg i.v. doses of ephedrine repeated after 2 min if not effective. Mild hypotension was defined as the patient requiring one dose of ephedrine 5 mg, moderate as 2 or 3 doses and severe as more than three doses of ephedrine. RESULTS: There were no differences between the study groups in the incidence or severity of hypotension. Thirteen patients (65%) in the leg wrapping group and 14 patients (70%) in the phenylephrine group remained normotensive at all times, whereas severe hypotension was noted in one patient in each group, without further complications. CONCLUSION: Wrapping of the legs is a nonpharmacological, prophylactic method with similar blood pressure control to repeated doses of phenylephrine during epidural anaesthesia for caesarean sections.

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