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Hemodynamic effects of a right lumbar-pelvic wedge during spinal anesthesia for cesarean section.
Int J Obstet Anesth. 2011 Oct; 20(4):307-11.IJ

Abstract

BACKGROUND

Aortocaval compression is a major cause of maternal hypotension. A randomized controlled trial was designed to determine the effectiveness of a mechanical intervention using a right lumbar-pelvic wedge in preventing hypotension after spinal anesthesia for cesarean delivery.

METHODS

Eighty healthy women undergoing elective cesarean section were randomly allocated immediately after spinal blockade to either a lumbar-pelvic wedge positioned under the right posterior-superior iliac crest (Wedge group, n=40) or the complete supine position (Supine group, n=40). Hemodynamic values, vasopressor consumption and adverse effects were collected during the surgical procedure. Hypotension was defined as a reduction in systolic blood pressure of 25% from baseline. Patient allocation, management and data collection were performed by a single unblinded anesthetist.

RESULTS

There was no difference in the incidence of hypotension between the two groups (42.5% vs. 50%, P=0.51). During the first 5 min, blood pressure decreased less in the Wedge group. There were significant differences in median [interquartile range] vasopressor requirements between the Wedge group and the Supine group (1 [0-2] vs. 3 [1-4] mg, P<0.01) and in nausea during the procedure (6 vs. 22 patients, P<0.01).

CONCLUSION

In our study population the use of right lumbar-pelvic wedge was not effective in reducing the incidence of hypotension during spinal anesthesia for cesarean section. Patients in whom the wedge was used had higher systolic blood pressure values during the first 5 min of anesthesia and fewer episodes of nausea. The risk of hypotension remains substantial.

Authors+Show Affiliations

Department of Anesthesiology, Universidad del Cauca, Popayân, Colombia. jacalvache@gmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

21852106

Citation

Calvache, J A., et al. "Hemodynamic Effects of a Right Lumbar-pelvic Wedge During Spinal Anesthesia for Cesarean Section." International Journal of Obstetric Anesthesia, vol. 20, no. 4, 2011, pp. 307-11.
Calvache JA, Muñoz MF, Baron FJ. Hemodynamic effects of a right lumbar-pelvic wedge during spinal anesthesia for cesarean section. Int J Obstet Anesth. 2011;20(4):307-11.
Calvache, J. A., Muñoz, M. F., & Baron, F. J. (2011). Hemodynamic effects of a right lumbar-pelvic wedge during spinal anesthesia for cesarean section. International Journal of Obstetric Anesthesia, 20(4), 307-11. https://doi.org/10.1016/j.ijoa.2011.06.010
Calvache JA, Muñoz MF, Baron FJ. Hemodynamic Effects of a Right Lumbar-pelvic Wedge During Spinal Anesthesia for Cesarean Section. Int J Obstet Anesth. 2011;20(4):307-11. PubMed PMID: 21852106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemodynamic effects of a right lumbar-pelvic wedge during spinal anesthesia for cesarean section. AU - Calvache,J A, AU - Muñoz,M F, AU - Baron,F J, Y1 - 2011/08/17/ PY - 2011/04/10/received PY - 2011/06/03/revised PY - 2011/06/28/accepted PY - 2011/8/20/entrez PY - 2011/8/20/pubmed PY - 2012/2/10/medline SP - 307 EP - 11 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 20 IS - 4 N2 - BACKGROUND: Aortocaval compression is a major cause of maternal hypotension. A randomized controlled trial was designed to determine the effectiveness of a mechanical intervention using a right lumbar-pelvic wedge in preventing hypotension after spinal anesthesia for cesarean delivery. METHODS: Eighty healthy women undergoing elective cesarean section were randomly allocated immediately after spinal blockade to either a lumbar-pelvic wedge positioned under the right posterior-superior iliac crest (Wedge group, n=40) or the complete supine position (Supine group, n=40). Hemodynamic values, vasopressor consumption and adverse effects were collected during the surgical procedure. Hypotension was defined as a reduction in systolic blood pressure of 25% from baseline. Patient allocation, management and data collection were performed by a single unblinded anesthetist. RESULTS: There was no difference in the incidence of hypotension between the two groups (42.5% vs. 50%, P=0.51). During the first 5 min, blood pressure decreased less in the Wedge group. There were significant differences in median [interquartile range] vasopressor requirements between the Wedge group and the Supine group (1 [0-2] vs. 3 [1-4] mg, P<0.01) and in nausea during the procedure (6 vs. 22 patients, P<0.01). CONCLUSION: In our study population the use of right lumbar-pelvic wedge was not effective in reducing the incidence of hypotension during spinal anesthesia for cesarean section. Patients in whom the wedge was used had higher systolic blood pressure values during the first 5 min of anesthesia and fewer episodes of nausea. The risk of hypotension remains substantial. SN - 1532-3374 UR - https://www.unboundmedicine.com/medline/citation/21852106/Hemodynamic_effects_of_a_right_lumbar_pelvic_wedge_during_spinal_anesthesia_for_cesarean_section_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(11)00074-4 DB - PRIME DP - Unbound Medicine ER -