Effect of Application of Lower Limb Venous Compression on Maternal Blood Pressure during Caesarean Section under Spinal Anaesthesia
N. M. Nkadam
Department of Anaesthesia, Obstetric Anaesthesia Unit, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
S. Fyneface-Ogan *
Department of Anaesthesia, Obstetric Anaesthesia Unit, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
A. T. Aggo
Department of Anaesthesia, Obstetric Anaesthesia Unit, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Maternal hypotension from spinal anaesthesia poses significant risks warranting continued search for effective prophylaxis.
Aim: The study aims to compare the effects of knee high (KH) and thigh high (TH) sequential compression stockings (SCS) on maternal blood pressure during Caesarean section under spinal anaesthesia.
Methods: Following Ethical approval, 150 consenting eligible parturients aged 18 – 45 years, of American Society of Anesthesiologists class I and II, scheduled for elective Caesarean, were randomized into KH, TH, and control (CT) groups, of 50 each. While groups KH and TH wore knee- high and thigh-high SCS respectively, including sham stockings, group CT wore sham stockings only. Following inflation of the SCS to 30-40 mmHg bilaterally, and 15 ml/kg 0.9% normal saline pre-loading, parturients received 2ml of hyperbaric bupivacaine 0.5% plus 25µg fentanyl, intrathecally, via L3/L4 intervertebral space in sitting position; post block heart rate, blood pressures were recorded. Hypotension was defined as > 20% decrease in baseline, or a systolic blood pressure < 90 mmHg.
Results: All 150 parturients completed the study. Hypotension occurred greatest [44 (37.9%)] in group CT, followed by group KH [40 (34.5%)] and least [32 (27.6%)] in group TH, p < 0.001, with significantly greatest ephedrine consumption in group CT, p = 0.008.
Conclusion: Knee-High and Thigh-High SCS application significantly reduced the incidence of maternal hypotension during Caesarean section under spinal anaesthesia, with superiority of the TH over the KH, and minimal side effects.
Keywords: Hypotension, sequential compression stockings, spinal anaesthesia