Compression Stockings: Does Placement Immediately Prior to Spinal Administration Reduce Hypotension?
Abstract Number: S-45
Abstract Type: Original Research
Hypotension is the most common adverse event seen in patients undergoing spinal anesthesia for cesarean section even with aggressive pre- and co-loading with crystalloids. Non-pharmacological prevention recommendations have included elastic compression stockings (TED hose). Leg wrapping has shown efficacy however TED hose has not. In this study, we investigated whether placement of TED hose immediately before spinal placement reduced the incidence of hypotension following spinal.
Materials and Methods
After informed consent, ten healthy patients scheduled for cesarean section were randomized to either wear TED hose or to the control group. No statistically significant difference existed between the groups in height, weight, or distribution of block. TED hose were placed after arrival in the operating room, immediately prior to spinal or combined spinal-epidural placement. All procedures were done in the sitting position. Bupivicaine 12.5mg, morphine 300mcg and fentanyl 25mcg were injected into the intrathecal space. Noninvasive blood pressures were taken every two minutes.
The average maximum blood pressure drop after administration of the spinal was 34.3% below mean for the compression stocking group and 35.8% below mean for the control group. The average mean blood pressure drop for the 30 minutes following spinal placement was 19.9% for the compression stocking group and 16.8% for the control group. An average of 150 mcg phenylephrine and 2.5 mg ephedrine was given to each of the women in the compression stocking group and 212.5 mcg phenylephrine and 1.25mg ephedrine was given to the women in the control group.
Researchers have explored for non-pharmaceutical means of preventing hypotension caused by spinal anesthesia during cesarean. Leg wrapping has been demonstrated to reduce the incidence of hypotension however TED hose has not. Sood et al placed compression stockings on patients one hour prior to spinal placement, potentially allowing redistribution of central blood volume. Our study placed compression stockings on immediately prior to the spinal and again did not see a significant decrease in hypotension rates. Compression stockings do not reliably prevent hypotension associated with spinal anesthesia.
1. Sood PK, et al: Thromboembolic deterrent stockings fail to prevent hypotension associated with spinal anaesthesia for elective caesarean section. Int J Obstet Anesth 1996, 5(3):172-175.