Hemodynamic effects of a right lumbar–pelvic wedge during spinal anesthesia for cesarean section

Calvache, Jose Andrés; Munoz, M.; Barón, Francisco

doi:10.1016/j.ijoa.2011.06.010

Cited by 21 publications

(10 citation statements)

References 28 publications

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“…3 Calvache et al revealed decrease consumption of ethylephrine in the lumbopelvic wedge group than in the supine group in their study. 18 The consumption of ephedrine was also significantly lower in lumbar than the pelvic wedge group in study performed by Zhou et al 19 The incidence of nausea vomiting and the neonatal Apgar score at 1 and 5 minutes were similar in both the group in our study.…”

Section: Discussionsupporting

confidence: 74%

“…In a study conducted by Calvache et al the use of right lumbar pelvic wedge was not effective in reducing the incidence of hypotension during spinal anesthesia for cesarean section. 18 However, they used a lumbar pelvic wedge rather than a pelvic wedge. They used 0.5% hyperbaric bupivacaine 9 mg with 20 mcg fentanyl whereas we used 10 mg 0.5% hyperbaric bupivacaine with 10 mcg fentanyl.…”

Section: Discussionmentioning

confidence: 99%

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Hemodynamic effects of right pelvic wedge in patients undergoing elective cesarean section under spinal anesthesia

Sigdel

Lama

Gurung

et al. 2018

Med. J. Pokhara Acad. Health Sci.

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Background: Several methods have been used to prevent post spinal hypotension including preloading, co-loading, use of vasopressors, placement of pelvic wedge, lumbar wedge and tilting of operating table in parturients undergoing cesarean section. We conducted a randomized controlled study to determine the hemodynamic effects of a standard pelvic wedge placed below the right hip immediately after the spinal block till the delivery of baby. Methods: One hundred consenting women undergoing elective cesarean section under spinal anesthesia were randomly allocated to wedge group (N=50) and control group (N=50). A standard wedge was placed under the right pelvis soon after spinal anesthesia till the delivery of baby in wedge group whereas the control group remained supine. Hemodynamic parameters including blood pressure, heart rate, vasopressor consumption, other side effects like nausea, vomiting and neonatal outcome were also recorded.Results: The incidence of hypotension and bradycardia was similar between groups (Wedge group 60% vs Control group 75.51%, p=0.125) before the birth of baby. The use of vasopressors (p=0.212), incidence of nausea (p=0.346) andApgar score at 1 and 5 minutes (p=0.629, p=0.442) were also not statistically significant. None of the patients had vomiting. Conclusion:In our study, the use of right pelvic wedge immediately after spinal anesthesia was not effective in preventing post spinal hypotension in elective cesarean section.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Hemodynamic effects of right pelvic wedge in patients undergoing elective cesarean section under spinal anesthesia

Sigdel

Lama

Gurung

et al. 2018

Med. J. Pokhara Acad. Health Sci.

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show abstract

“…The headline results from a recent study suggested that there was no difference in the incidence of hypotension between women managed supine during CS and those who had a firm wedge under the pelvic and lumbar region, but there was less early hypotension, smaller vasopressor doses, and less nausea in the latter group. 12 We also cannot predict the small percentage of women who may develop severe cardiovascular collapse or cardiac arrest while supine after spinal anaesthesia, a situation that once triggered may not be immediately relieved by the lateral position. 13 With non-invasive technologies, we are progressing towards a state where we can tailor the degree of lateral tilt according to the woman's responses.…”

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confidence: 98%

II. Lateral tilt at Caesarean section: one angle fits all or made-to-measure?

Kinsella

2012

British Journal of Anaesthesia

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“…[ 2 3 ] A routine practice of treatment for hypotension after adequate fluid loading and left lateral tilt during spinal anesthesia is with vasopressors such as ephedrine, mephentermine, and phenylephrine. [ 3 4 ] These agents have their adverse effects such as tachycardia, headache with higher doses. By wrapping the legs with crepe bandage (CB), the pooling of blood in lower limbs can be prevented.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic changes under spinal anesthesia after elastic wrapping or pneumatic compression of lower limbs in elective cesarean section: A randomized control trial

Prajith

Mishra

Ravishankar

et al. 2020

J Anaesthesiol Clin Pharmacol

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Background and Aims: In spite of adequate fluid loading and left lateral tilt, parturients develop hypotension under spinal anesthesia during cesarean section. Elastic crepe bandage (CB) or pneumatic compression device (PCD) can be utilized to prevent the pooling of blood in lower limbs and thereby it may reduce the incidence of hypotension in these patients. This study was formulated to analyze the hemodynamic effects of leg wrapping with elastic CB and PCD in parturients undergoing for cesarean section under anesthesia. Material and Methods: Ninety term obstetric patients posted for elective cesarean section under spinal anesthesia were randomized into 3 groups: Group 1 (control), Group 2 (CB), and Group 3 (PCD). All the parturients had their legs wrapped with an elastic bandage and pneumatic sleeve applied over it. In Group 1 (Control), patients had their legs wrapped with CB loosely and pneumatic sleeve also applied was switched on. In Group 2, patients the CB was applied by stretching the bandage (15 cm width and 4 m stretched length). The PCD was not switched on in this group. In Group 3, the legs were wrapped with the CB loosely. The pneumatic sleeve was applied over the bandage, and the machine was switched on with a preset pressure of 40–50 mmHg after spinal anesthesia. Incidence of maternal hypotension and ephedrine requirement to maintain systolic blood pressure, neonatal Apgar score were recorded. Results: The incidence of hypotension was significantly lower in Group 2 and 3 than the control group. Similarly, the requirement of ephedrine was significantly high in control group compared to CB and PCD. The incidence of hypotension was lower in group CB than group PCD. Meantime to receive the first dose of ephedrine was significantly low in control (7.37 ± 4.94 min) as compared to CB (10 ± 2.8 min) and PCD (13.88 ± 9.23). Conclusion: Leg-wrapping with CB is cost-effective, non-invasive, non-pharmacological, and effective tool to reduce the incidence of hypotension after spinal anesthesia in a parturient.

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Hemodynamic effects of a right lumbar–pelvic wedge during spinal anesthesia for cesarean section

Cited by 21 publications

References 28 publications

Hemodynamic effects of right pelvic wedge in patients undergoing elective cesarean section under spinal anesthesia

Hemodynamic effects of right pelvic wedge in patients undergoing elective cesarean section under spinal anesthesia

II. Lateral tilt at Caesarean section: one angle fits all or made-to-measure?

Hemodynamic changes under spinal anesthesia after elastic wrapping or pneumatic compression of lower limbs in elective cesarean section: A randomized control trial

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