- Cesarean delivery is frequently performed under spinal anesthesia. However, despite the administration of prophylactic vasopressors, spinal anesthesia can still result in hypotension with potential maternal and neonatal consequences, including compromised uteroplacental perfusion and neonatal acidosis.
- Previous studies have suggested that mechanical interventions, such as elevating or compressing patients’ legs, could reduce the incidence of hypotension after spinal anesthesia, presumably through enhancing venous return and increasing cardiac preload.
- This randomized controlled trial evaluated the effect of 30° leg elevation on norepinephrine (noradrenaline) requirements after spinal anesthesia for elective cesarean delivery.
- The authors hypothesized that passive leg elevation during cesarean delivery under spinal anesthesia could reduce the incidence of hypotension and need for vasopressors.
- 80 pregnant patients undergoing elective primary cesarean delivery under spinal anesthesia were randomized to either a leg elevation or a control group.
- In the leg elevation group, a standardized pillow with a height of 30 cm was placed beneath the heels to achieve an approximate hip flexion angle of 30°. In the control group, the patients’ hips remained extended. Both groups were placed in a 15° left uterine displacement position.
- Following placement of the spinal anesthetic, a norepinephrine infusion was administered via a standardized algorithm to maintain blood pressure within 10% of each patient’s baseline.
- The level elevation group had a significantly lower mean noradrenaline requirement compared to the control group (0.067 ± 0.01 and 0.079 ± 0.01 µg/kg/min; p < 0.05).
- In addition, the incidence of hypotension was reduced in the leg elevation group (20%) compared to the control group (40%).
- Although umbilical artery pH was statistically higher in the leg elevation group, values in both groups remained within the normal physiological range.
- Neonatal outcomes were otherwise comparable between groups.
- The authors concluded that in healthy parturients undergoing elective cesarean section under spinal anesthesia, passive leg raising significantly reduced norepinephrine requirements and was associated with a significantly lower incidence of hypotension.
Summary of "The influence of thirty-degree leg elevation on noradrenaline requirements administered as a prophylactic variable infusion during cesarean delivery, an open-label randomized controlled trial"
Summary published March 23, 2026
