Lower limb wrapping prevents hypotension, but not hypothermia or shivering, after the introduction of epidural anesthesia for cesarean delivery.
The decrease of arterial blood pressure and body temperature after epidural or spinal anesthesia is thought to be the result of sympathetic block, which could cause pooling and redistribution of blood into the lower extremities. Studies have demonstrated that leg wrapping with elastic bandages may reduce the incidence of hypotension after spinal anesthesia. We tried to extend these previous observations to epidural anesthesia by testing the hypothesis that leg wrapping with elastic bandages should decrease the incidence of hypotension in patients receiving epidural anesthesia. Moreover, we evaluated the effect of this maneuver as regards hypothermia and shivering. Sixty parturients were randomly allocated to receive either leg wrapping with tight elastic bandages (leg-wrapped group) or not (control group) before anesthesia. Sublingual temperature was observed at five periods: baseline, immediately after epidural anesthesia, abdominal skin disinfection, skin incision, and delivery. Hypotension and shivering during the observation periods were also recorded. The incidence of hypotension was significantly less frequent (P = 0.03) in the leg-wrapped group (23%) compared with the control group (50%). Shivering incidences were similar in both groups (70% versus 70%). Sublingual temperature decreased significantly (P < 0.001) throughout the procedure in each group. However, no differences were found between the two groups at each designated observation, even if compared by the magnitude of temperature decrease. We conclude that although leg wrapping with elastic bandages prevents maternal hypotension after epidural anesthesia, it does not reduce the incidence or magnitude of hypothermia or prevent shivering.
*Department of Anesthesiology and †Cathay Medical Research Institute, Cathay General Hospital, Taipei, Taiwan; ‡Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan; and §Department of Anesthesiology, Pain Service and Critical Care Medicine, China Medical College Hospital, Taipei, Taiwan.
Hsiao Lun
HL
Sun
Qing Dong
QD
Ling
Wei Zen
WZ
Sun
Rick Sai-Chuen
RS
Wu
Tzong Jeng
TJ
Wu
Shih Chieh
SC
Wang
Chih Cheng
CC
Chien
D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D001458:Bandages; D001794:Blood Pressure / Q000502:physiology; D002585:Cesarean Section; D004809:Ephedrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007022:Hypotension / Q000517:prevention & control*; D007035:Hypothermia / Q000517:prevention & control*; D007866:Leg / Q000502:physiology*; D011247:Pregnancy; D012768:Shivering / Q000502:physiology*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D004809:Ephedrine