Effect of pneumatic leg compression on phenylephrine dose for hypotension prophylaxis via variable rate infusion at...

Phenylephrine infusion is recommended to prevent spinal hypotension during cesarean delivery (CD) but may be associated with dose-dependent side effects. We hypothesized that adding intermittent pneumatic compression (IPC) of the lower legs to a variable-rate phenylephrine infusion will reduce the dose of phenylephrine required during CD.

Seventy-six healthy women undergoing elective CD under combined spinal-epidural anesthesia were randomly assigned to IPC or control groups (n = 38 per group). After spinal anesthesia, IPC of the lower legs was initiated in the IPC group, and all women received a phenylephrine infusion starting at 25 μg·min^-1 and increasing by 16.7 μg·min^-1 for systolic blood pressure (SAP) < 90% baseline. If hypotension (SAP < 80% baseline) occurred, 100 μg phenylephrine bolus was administered. The primary outcome was the dose of phenylephrine per minute.

The dose of phenylephrine per minute (34.4 ± 7.3 μg·min^-1 vs. 40.9 ± 9.5 μg·min^-1, P = 0.001; mean difference -6.6 μg·min^-1, 95% CI -10.5 to -2.7 μg·min^-1) and the incidence of hypotension (24% vs. 55%, P = 0.005) were lower in the IPC group than in the control group. There were no significant differences between the two groups in the total dose of phenylephrine (603.2 ± 217.1 μg vs. 706.2 ± 247.5 μg, P = 0.058; mean difference -102.9 μg, 95% CI -209.4 to 3.5 μg), maternal side effects, or neonatal outcomes.

Intermittent pneumatic compression combined with a variable-rate phenylephrine infusion reduced the phenylephrine dose per minute and the incidence of hypotension during CD under spinal anesthesia.