Background & Aim: Spinal anesthesia is commonly used for cesarean section, but it is usually associated with side effects like hypotension, which may be detrimental to mother and baby. Over past few years, many pharmacological interventions have been tried to prevent hypotension, but no single technique has proven to be ideal. This study was carried out with the aim to find whether wrapping the legs with elastic crepe bandage in addition to conventional approach was effective in preventing hypotension due to spinal anesthesia.

Method: A total of 60 full-term patients 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 (Group A) or no wrapping(Group B). All patients were administered intravenous (IV) crystalloid (20 ml/kg) 15-20 min prior to spinal anesthesia. 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 surgery. Hypotension was treated with IV phenylephrine 50 µg.

Results: The incidence of hypotension was significantly less (P = 0.002) in Group A (legs wrapped group) when compared with Group B (non leg wrapped). In Group A 3 (10%) patients and in Group B 15(50%) patients required rescue dose with phenylephrine which was statistically significant (P = 0.004). Difference in the systolic, diastolic and mean arterial pressure between Group A and B was recorded and found significant between 4 to 15 min after spinal anesthesia.

Conclusion: There was less incidence of hypotension due to wrapping of legs with elastic crepe bandage with a subsequent reduction in the requirement of of phenylephrine. Leg wrapping with crepe bandage is cheap, easy, readily available, noninvasive, and non pharmacological and most important it had least effect on baby. So leg wrapping can be recommended for preventing hypotension in spinal anesthesia.

Key words-Leg wrapping, hypotenson,spinal anaesthesia.

1.      Rocke DA, Rout CC. Volume preloading, spinal hypotension and caesarean section. Br J Anaesth 1995;75:257-9.

2.      JK Mitra, J Roy, P Bhattacharya, M. Yunus, NM Lyngdon. Changing trends in management of hypotension following spinal hypotension in cesarean section. Review Article 2013;59:121-126.

3.      Williamson W, Burks D, Pipkin J, Burkard JF, Osborne LA, Pellegrini JE. Effect of timing of fluid bolus on reduction of spinal-induced hypotension in patients undergoing elective cesarean delivery. AANA J 2009;77:130-6.

4.      Dahlgren G, Granath F, Wessel H, Irestedt L. Prediction of hypotension during spinal anesthesia for cesarean section and its relation to the effect of crystalloid or colloid preload. Int J ObstetAnesth 2007;16:128-34.  

5.      Mercier FJ. Fluid loading for cesarean delivery under spinal anesthesia: Have we studied all the options? AnesthAnalg 2011;113:677-80

6.      Banerjee A, Stocche RM, Angle P, Halpern SH. Preload or coload for spinal anesthesia for elective Cesarean delivery: A meta-analysis. Can J Anaesth 2010; 57:24-31

7.      Mercier FJ. Cesarean delivery fluid management. CurrOpinAnaesthesiol 2012; 25:286-91

8.      NganKee WD, Khaw KS, Tan PE, Ng FF, Karmakar MK. Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology 2009; 111:506-12. 

9.      Landau R, Liu SK, Blouin JL, Smiley RM, NganKee WD. The effect of maternal and fetal β2-adrenoceptor and nitric oxide synthase genotype on vasopressor requirement and fetal acid-base status during spinal anesthesia for cesarean delivery.  AnesthAnalg 2011;112:1432-7

10.  Stewart A, Fernando R, McDonald S, Hignett R, Jones T, Columb M. The dose-dependent effects of phenylephrine for elective cesarean delivery under spinal anesthesia. AnesthAnalg 2010;111:1230-7

11.  Cooper DW. Caesarean delivery vasopressor management. CurrOpin Anaesthesiol 2012;25:300-8. 

12.  Habib AS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. AnesthAnalg 2012;114:377-90

13.  Armstrong S, Fernando R, Columb M. Minimally-and non-invasive assessment of maternal cardiac output: Go with the flow! Int J ObstetAnesth 2011;20:330-40

14.  Langesæter E, Dyer RA. Maternal haemodynamic changes during spinal anaesthesia for caesarean section. Curr Opin Anaesthesiol 2011;24:242-8.

15.  Singh K, Payal YS, Sharma JP, Nautiyal R. Evaluation of hemodynamic changes after leg wrapping in elective cesarean section under spinal anesthesia. J Obstet Anaesth Crit Care 2014;4:23-8.

16.  Rout C C, Rocke DA, Gouws E. Leg elevation and wrapping in the prevention of hypotension following spinal anaesthesia for elective cesarean section. Anaesth 1993 Apr ; 48(4)304-8.

17.  Von Bogaert L.J. Prevention of post spinal hypotension at elective cesarean section by wrapping of lower limbs. Int. J. Gynaecology and obstetrics. 1998 june ; 61(3);233-8.

18.  Goudie TA, Winter AW, Feguson DJ. Lower limb compression using inflatable splints to prevent hypotension during spinal anaesthesia for caesarean section. ActaAnaesthesiolScand 1988;32:541-544.

19.  Bhagwanjee S, Rocke DA, Rout CC, Kooverjee RV, Brijbal R. Prevention of post spinal hypotension following the spinal anaesthesia for elective caesarean section by wrapping of legs. Br. J. Anaesth. 1990 dec, 65(6): 819-22

20.  Jorgensen J, Christensen PK, Sonnenschein CH. Compression stockings as prevention of hypotension in cesarean section during spinal anaesthesia. Ugeskrift for laeger 1996, 158(11):1526-1529.