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.

BACKGROUND: Spinal anesthesia is the preferred technique for elective cesarean delivery; however, it is frequently associated with spinal anesthesia-induced hypotension. To mitigate this, prophylactic vasopressors have become a cornerstone of obstetric anesthesia practice. Despite their use, hypotension may still occur, prompting the exploration of adjunctive maneuvers to enhance hemodynamic stability and reduce vasopressor requirements. This study hypothesized that passive leg elevation would reduce the need for noradrenaline during cesarean delivery under spinal anesthesia. METHODS: In this randomized controlled trial, we evaluated the effect of 30-degree leg elevation on noradrenaline requirements. Noradrenaline was administered as a variable infusion, ranging from 0.05 to 0.14 µg/kg/min. Participants were randomly assigned to either the control group or the leg elevation group. The primary outcome was the average noradrenaline requirement in each group. RESULTS: A total of 80 healthy pregnant patients were included in the final analysis, with 40 patients in each group. The mean noradrenaline requirement was significantly lower in the leg elevation group compared to the control group (0.067 ± 0.01 vs. 0.079 ± 0.01 µg/kg/min, respectively; p < 0.05). Additionally, the incidence of hypotension was reduced in the leg elevation group (20%) compared to the control group (40%). CONCLUSION: Among healthy parturients undergoing elective cesarean section, passive leg elevation significantly reduced noradrenaline requirements and was associated with a lower incidence of hypotension. This simple maneuver may serve as a valuable adjunct to pharmacologic prophylaxis in spinal anesthesia. TRIAL REGISTRATION: The study was registered by the principal investigator (M. Helmy) at ClinicalTrials.gov under the identifier NCT06822699 on February 7, 2025.