Nonpneumatic Anti-Shock Garment versus Intermittent Sequential Compression Device for Prevention of Postspinal Hypotension in Patients Undergoing Cesarean Section: A Randomized Controlled Study

CONTEXT: Postspinal hypotension remains a frequent complication of subarachnoid block during cesarean section causing further maternal and fetal adverse effects. AIMS: This study aims to evaluate and compare a continuous pressure nonpneumatic anti-shock garment (NASG) and an intermittent sequential compression device (SCD) with a control group for prevention of postspinal hypotension in women undergoing elective cesarean section. SETTINGS AND DESIGN: A randomized, observer blind, controlled study at single university hospital. SUBJECTS AND METHODS: Ninety singleton term parturients between 18 and 35 years of age undergoing cesarean section with spinal anesthesia were randomly assigned to be applied with NASG, SCD, or no device; n = 30 in each group. A standardized protocol for cohydration and anesthetic technique was followed. The primary outcome measure was incidence of hypotension defined as a decrease in systolic blood pressure of more than 20% from baseline or an absolute value <100 mmHg, whichever was higher. The secondary outcome measures were median dose of ephedrine required, incidence of maternal nausea and vomiting, and neonatal Apgar scores. STATISTICAL ANALYSIS USED: Results were expressed as mean (±standard deviation), median (range), or number (%) as appropriate. Nominal data were compared using Chi-square/Fischer's exact test. Continuous data were compared using ANOVA one-way test. Nonparametric data were compared using Kruskal–Wallis test. RESULTS: In Groups NASG, SCD, and C, incidence of hypotension was 60%, 83%, and 90%, respectively (P = 0.021), with significant reduction in incidence of hypotension in Group NASG versus Group C (P < 0.001, odds ratio 0.17, 95% confidence interval 0.04–0.68). Median (interquartile range) dose of ephedrine required was significantly less in Group NASG compared with Groups SCD and C, respectively (P = 0.002, P < 0.001). CONCLUSIONS: NASG proved to be a more effective device for prevention of postspinal hypotension when compared with application of SCD or no device.