COMPARISON OF EFFECTS OF TRENDELENBURG 20 DEGREE, PASSIVE LEG RAISING AT 45 DEGREES AND SUPINE POSITION ON HEMODYNAMIC CHANGES AFTER TOURNIQUET DEFLATION IN ORTHOPEDIC LOWER LIMB SURGERY UNDER SPINAL ANESTHESIA, A PROSPECTIVE PARALLEL CONTROLLED STUDY
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Keywords
Tourniquet deflation, Trendelenburg position, Passive leg raising, Hemodynamic changes, Spinal anesthesia, Orthopedic surgery
Abstract
Background: Pneumatic tourniquets are frequently used in orthopedic lower limb surgeries to minimize intraoperative blood loss and enhance the surgical field. However, tourniquet deflation can lead to hemodynamic instability, including hypotension and tachycardia. Physical maneuvers such as the Trendelenburg and passive leg raising (PLR) positions have been used to counteract these changes, but their comparative efficacy remains underexplored.
Aim: To compare the effectiveness of the Trendelenburg position, passive leg raising, and supine positioning in attenuating hemodynamic disturbances following tourniquet deflation in patients undergoing lower limb surgery under spinal anesthesia.
Methods: A prospective, randomized study was conducted on 90 ASA I–II patients undergoing lower limb surgery under spinal anesthesia. Patients were divided into three groups of 30 each: Group T (Trendelenburg), Group P (PLR), and Group C (supine control). Hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, post-deflation, and at regular intervals for 15 minutes. Total intravenous fluid requirement and need for vasopressors were also noted.
Results: Trendelenburg positioning resulted in significantly better maintenance of SBP, MAP, and HR after tourniquet deflation compared to the PLR and supine groups (p < 0.05). Group T also required a significantly lower volume of crystalloids (1.9 ± 0.40 L) compared to Group P (2.33 ± 0.47 L) and Group C (2.14 ± 0.67 L) (p = 0.007). No patient in the Trendelenburg group required vasopressor support, whereas isolated cases in Groups P and C did. The incidence of complications was lower in Group T, although not statistically significant.
Conclusion: The Trendelenburg position is superior to passive leg raising and supine positioning in maintaining hemodynamic stability and reducing fluid requirement following tourniquet deflation in lower limb surgeries under spinal anesthesia. It is a simple and effective intervention that can be safely implemented in the operating room to prevent post-deflation hypotension.
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All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Akshaya A
DnB, Department of Anesthesiology, Deen Dayal Upadhyay Hospital, Hari Nagar, New Delhi, India.
Dr. Rashmijit Behera
DnB, Department of Anesthesiology, Deen Dayal Upadhyay Hospital, Hari Nagar, New Delhi, India.