Kumar Ajay, Kurdi Madhuri, H Harshitha, Theerth Kaushik
Anaesthesiology, Shri Atal Bihari Vajpayee Medical College and Research Institution, Bengaluru, IND.
Anaesthesiology, Karnataka Medical College and Research Institute, Hubballi, IND.
Cureus. 2025 Mar 9;17(3):e80311. doi: 10.7759/cureus.80311. eCollection 2025 Mar.
Background and objectives Post-spinal hypotension (PSH) is most commonly encountered in patients undergoing lower-segment caesarean section (LSCS). Passive leg raising (PLR) has been attempted in septic shock to predict fluid responsiveness. PLR is a novel and less-tried manoeuvre to prevent PSH in patients undergoing LSCS. This study aimed to compare the efficacy of PLR and prophylactic phenylephrine infusion in preventing PSH. Methods With the Ethical Committee's approval and patient consent, this randomized controlled trial included 180 parturients undergoing elective LSCS. The effects of PLR and phenylephrine infusion were compared. Parturients in the leg elevation group received leg raising approximately 30 cm from the horizontal position with a wooden block for three minutes. Parturients in the phenylephrine group received phenylephrine infusion at 100 µg/minute for three minutes following subarachnoid block. Those in the control group did not receive any intervention. Baseline systolic and diastolic blood pressure and heart rate were recorded every minute for three minutes and then every three minutes until the delivery of the foetus. Fetal appearance, pulse, grimace, activity and respiration (APGAR) score were noted at the first and fifth minute following birth. Any episodes of hypotension, hypertension or bradycardia were recorded. Results The incidence of hypotension was maximum in the control group (n = 23, or 38.3%), followed by the phenylephrine group (n = 4, or 6.7%) and least in the leg elevation group (n = 3, or 5.0%). The difference in the incidence rates was statistically significant (p < 0.05). The incidence rates of hypertension and bradycardia were not significant in any of the groups. The neonatal outcome was the same in all three groups. Conclusion PLR is a better alternative to prophylactic phenylephrine infusion in preventing PSH.
脊髓麻醉后低血压（PSH）最常见于接受下段剖宫产术（LSCS）的患者。被动抬腿（PLR）已被用于感染性休克患者以预测液体反应性。PLR是一种预防接受LSCS患者发生PSH的新方法且较少尝试。本研究旨在比较PLR和预防性去氧肾上腺素输注预防PSH的疗效。方法：经伦理委员会批准并获得患者同意，本随机对照试验纳入了180例行择期LSCS的产妇。比较PLR和去氧肾上腺素输注的效果。腿部抬高组的产妇用木块将腿从水平位置抬高约30厘米，持续三分钟。去氧肾上腺素组的产妇在蛛网膜下腔阻滞后置入去氧肾上腺素，以100μg/分钟的速度输注三分钟。对照组未接受任何干预。在三分钟内每分钟记录一次基线收缩压、舒张压和心率，然后每三分钟记录一次，直至胎儿娩出。在出生后第一分钟和第五分钟记录胎儿外观、脉搏、皱眉、活动和呼吸（APGAR）评分。记录任何低血压、高血压或心动过缓发作情况。结果：对照组低血压发生率最高（n = 23，即38.3%），其次是去氧肾上腺素组（n = 4，即6.7%），腿部抬高组最低（n = 3，即5.0%）。发生率差异具有统计学意义（p < 0.05）。高血压和心动过缓的发生率在任何组中均无显著差异。三组的新生儿结局相同。结论：在预防PSH方面，PLR是预防性去氧肾上腺素输注的更好替代方法。
