Can Passive Leg Raise Prevent Spinal Anesthesia-induced Hypotension During Cesarean Section?

Study Overview
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Brief Summary
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All over the world, spinal anesthesia is widely used in cesarean sections due to its superiority over general anesthesia. Due to reasons such as increased sensitivity to local anesthetics and increased intra-abdominal pressure in pregnant women, the frequency of hypotension increases by up to 70%. As a result of the blockage of sympathetic vasoconstrictor fibers originating from T1-L2 segments, loss of peripheral resistance, venous ponding occurs, and cardiac output decreases. Also, the level required for cesarean operation is T4 or T5, and the possibility of affecting the cardiac accelerator fibers, so bradycardia due to the increase in parasympathetic activity may deepen the hypotension. If postspinal hypotension is not managed correctly, it may lead to maternal and fetal complications. In addition to classical methods such as fluid loading and prophylactic vasoconstrictor application to prevent hypotension in pregnant women after spinal anesthesia, techniques such as wrapping the lower extremity, lifting, or applying both together have been in question. Passive leg raise application is an easy method that allows the blood collected in the lower part of the body to participate in the central circulation with the effect of gravity. An increase in venous return occurs with the passage of blood from the lower extremities to the thorax. Thus, it leads to an increase in stroke volume and an increase in cardiac output. In this study, we aimed to determine the effectiveness of passive leg raising in preventing or reducing the depth of hypotension after spinal anesthesia in pregnant women who underwent cesarean section under spinal anesthesia.

Official Title
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Can Passive Leg Raise Prevent Spinal Anesthesia-induced Hypotension During Cesarean Section?

Conditions
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Hypotension

Intervention / Treatment
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* Other: Passive leg Raise
* Other: control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Parturients who are planned for the elective cesarean section Exclusion Criteria: Failed spinal block Shift to general anesthesia Severe cardiac disease Hypertensive disorders of pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Passive leg raise<br>group for passive leg raise | Other: Passive leg Raise<br>* The intervention will be performed immediately after spinal anesthesia, and passive leg raise will be performed using two standard pillows placed under the heel so that the leg is approximately 30 cm above the horizontal plane of the table. The passive leg raising position will continue until the cord is clamped.<br>|
| Placebo Comparator: Control<br> | Other: control<br>* The controlled group was positioned in the normal supine position.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Systolic blood pressure | Systolic blood pressure will be recorded from the monitor | Before the spinal anesthesia in the supine position | 
| Systolic blood pressure | Systolic blood pressure will be recorded from the monitor | 1 minute after the spinal anesthesia in the supine position | 
| Systolic blood pressure | Systolic blood pressure will be recorded from the monitor | 2 minutes after the spinal anesthesia in the supine position | 
| Systolic blood pressure | Systolic blood pressure will be recorded from the monitor | 3 minutes after the spinal anesthesia in the supine position | 
| Systolic blood pressure | Systolic blood pressure will be recorded from the monitor | 4 minutes after the spinal anesthesia in the supine position | 
| Systolic blood pressure | Systolic blood pressure will be recorded from the monitor | 5 minutes after the spinal anesthesia in the supine position | 
| Systolic blood pressure | Systolic blood pressure will be recorded from the monitor | 7 minutes after the spinal anesthesia in the supine position | 
| Systolic blood pressure | Systolic blood pressure will be recorded from the monitor | 9 minutes after the spinal anesthesia in the supine position | 
| Systolic blood pressure | Systolic blood pressure will be recorded from the monitor | 11 minutes after the spinal anesthesia in the supine position | 
| Systolic blood pressure | Systolic blood pressure will be recorded from the monitor | 1 minute after the umblical cord clamping | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cesarean section, hypotension, spinal anesthesia, passive leg raise