The use of leg elevation in the treatment of chronic peripheral oedema.

Chronic peripheral oedema is a common long-term condition, with conflicting evidence on how it is best managed. It is crucial to establish the cause of the oedema to decide on the most appropriate intervention for its management. If the oedema is not managed, it can lead to unwanted complications for the service user. The District Nurse (DN) is pivotal in the management of patients with long-term conditions, both directly and indirectly. It is important that a multi-disciplinary approach is used, although nurses are now more autonomous due to advances in practice. The present study focuses on leg elevation as a form of intervention in the treatment of chronic peripheral oedema. As with any intervention, there are some risks with leg elevation that must be considered. This should be disseminated and monitored effectively.

Effect of Leg Elevation Height on Reduced Swelling of Patients of Postoperative Acute Ankle Fractures / 대한족부족관절학회지

PURPOSE: Leg elevation is known as an effective method for reducing leg swelling, and it has been routinely used in medical practice. However, the effect of swelling reduction in relation to the degree of elevation height is not known. This study evaluated the swelling of the leg after acute ankle fracture operations at two different elevation heights and the elevated leg heights were compared.MATERIALS AND METHODS: A total of 66 patients with postoperative acute ankle fractures were classified into two groups depending on the presence of different leg elevation heights: high-elevated (HE, case) and low-elevated groups (LE, control). We checked leg swelling, pain, subjective satisfaction for the elevation device, and the American Orthopedic Foot and Ankle Society (AOFAS) score, and we retrospectively compared them between both the groups.RESULTS: Leg swelling and pain were reduced in both groups. However, they did not show any significant differences between both the groups (p>0.05). Nineteen patients in the HE group replied with uncomfortable, while no patients in LE group did so. The AOFAS score at 1 year postoperatively did not show any significant differences between both the groups (p=0.46).CONCLUSION: High elevation of the leg after ankle fractures did not show a significant difference from low elevation in regard to leg swelling, pain, and function. Furthermore, high leg elevation resulted in discomfort during the postoperative period. Thus, low elevation with a pillow is enough for acute ankle fracture patients with little discomfort and satisfactory swelling reduction.

Leg elevation decreases the incidence of post-spinal hypotension in cesarean section: a randomized controlled trial.

BACKGROUND: Maternal hypotension is a common complication after spinal anesthesia for cesarean section (CS). In this study we investigated the role of leg elevation (LE) as a method for prevention of post-spinal hypotension (PSH) for cesarean section. METHODS: One hundred and fifty full term parturients scheduled for CS were included in the study. Patients were randomized into two groups: Group LE (leg elevation group, n = 75) and group C (Control group, n = 75). Spinal block was performed in sitting position after administration of 10 mL/Kg Ringer's lactate as fluid preload. After successful intrathecal injection of local anesthetic, Patients were positioned in the supine position. Leg elevation was performed for LE group directly after spinal anesthesia and maintained till skin incision. Intraoperative hemodynamic parameters (Arterial blood pressure and heart rate), intra-operative ephedrine consumption, incidence of PSH, and incidence of nausea and vomiting were reported. RESULTS: LE group showed lower incidence of PSH (34.7% Vs 58.7%, P = 0.005) compared to the control group. Arterial blood pressure was higher in the LE group compared to the control group in the first two readings after spinal block. Other readings showed comparable arterial blood pressure and heart rate values between both study groups; however, LE showed less ephedrine consumption (4.9 ± 7.8 mg Vs 10 ± 11 mg, P = 0.001). CONCLUSION: LE performed immediately after spinal block reduced the incidence of PSH in parturients undergoing CS. TRIAL REGISTRATION: The study was registered at Pan African Clinical Trials Registry system on 5/10/2015 with trial number PACTR201510001295348 .

Effect of taleeq (leech therapy) in dawali (varicose veins).

Dawali (varicose vein) is first described in Ebers Papyrus over 3500 years ago. Dawali is a disease in which veins of legs and feet become dilated, tortuous, and greenish in colour due to excess accumulation of blood which is derived from saudavi madda & balgham ghaleez. The aetiology of varicose veins is still incompletely under stood, despite the fact that it is a very common disease affecting all ages from teenagers to elderly people. The complication of varicose veins like venous eczema, venous pigmentation, lipodermatosclerosis, superficial thrombophlebitis, venous ulceration, etc impair health related quality of life significantly. The objective of the study is to evaluate the efficacy of Taleeq in Dawali and to provide safe & cost effective alternative treatment. Randomized controlled clinical open trial was conducted in regimenal unit of NIUM Hospital. 50 patients were divided into 2 groups, 30 in test & 20 in control group. Test group was treated with Taleeq on alternate day & control group was treated with grade 2 compression stockings & limb elevation for 2 months. Response was measured by assessment of pain / leg discomfort, limb girth at calf, ankle, and feet, pigmentation area & colour on every 15(th) day. Hb% was assessed on every 15(th) day to check anaemia. Effect on anatomy of vein was assessed by colour flow Doppler USG. Test group showed significant reduction in pain, limb girth, pigmentation, number of perforators. Control group showed significant reduction in pain & limb girth, but there was no improvement on pigmentation. Both groups do not show significant improvement on SFJ & SPJ incompetency. Test group has major effects in improvement of all parameters. Study stresses that leech therapy should be administered in combination with compression stockings & other effective treatment modalities like weight normalization for obese patients, physical therapy, dietary modification etc for optimal results.