Leg Compression Versus Control for Prevention of Spinal Anesthesia Induced Hypotension in Elective Cesarean Delivery: A Meta-Analysis of Randomized Controlled Trials

PurposeThe aim of this meta-analysis was to assess the effectiveness of leg compression versus control in preventing spinal anesthesia induced hypotension during cesarean delivery.DesignA meta-analysis of randomized controlled trials (RCTs).MethodsPubMed, Embase, Web of Science and CENTRAL were searched for RCTs that compared leg compression with control for prevention of hypotension in patients undergoing elective cesarean delivery under spinal anesthesia. The primary outcome was the incidence of hypotension. Subgroup analysis was performed according to leg compression methods. Secondary outcomes included nausea and vomiting, the number of vasopressor requirement, and the rates of neonatal Apgar scores ≤7 and umbilical cord blood pH ≤ 7.2.FindingsTwelve studies involving 787 patients were included in this meta-analysis. There was a significant reduction of the incidence of hypotension with leg compression versus control (RR 0.45, 95% CI 0.32 to 0.62, I² = 81%). Subgroup analysis suggested that leg wrapping may be more effective in preventing hypotension compared with elastic stockings and sequential compression mechanical devices. Leg compression also reduced maternal nausea and vasopressors requirement, but did not impact on neonatal outcomes.ConclusionsLeg compression, especially leg wrapping, decreases the incidence and severity of hypotension after spinal anesthesia in caesarean delivery. As a simple, non–pharmacologic and cost-effective intervention, leg wrapping can be used for prevention of spinal anesthesia induced hypotension in caesarean delivery, either alone or in combination with vasopressors.