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Background and Aims Spinal anesthesia is the preferred technique for cesarean sections due to its favorable profile; however, post-spinal hypotension (PSH) remains a frequent and dangerous hemodynamic complication. Despite numerous preventive approaches, the optimal non-pharmacological strategy remains controversial. We aimed to evaluate the efficacy of leg elevation (LE) versus no leg elevation (no LE) in reducing PSH in women undergoing elective cesarean section.Methods We conducted a systematic search in PubMed, Cochrane and Embase for randomized controlled trials comparing LE with no LE in elective cesarean sections. Studies reporting the incidence of PSH, vasopressor consumption, and heart rate changes were included. Statistical analysis was performed using a random-effects model with the Hartung-Knapp-Sidik-Jonkman method, and heterogeneity was estimated via the Restricted Maximum Likelihood approach.Results A total of six RCTs comprising 505 patients were analyzed. LE significantly reduced the incidence of PSH (risk ratio: 0.63; 95% CI: 0.51–0.79; p = 0.0001), equating to a 37% risk reduction. Additionally, the LE group demonstrated a significantly lower requirement for ephedrine (mean difference: -5.51 mg; 95% CI: -7.46 to -3.56; p < 0.00001). In contrast, no significant difference in heart rate was observed between the groups (mean difference: 4.02; 95% CI: -11.40 to 19.44; p = 0.26).Conclusions In this meta-analysis of randomized controlled trials, LE significantly reduced the risk of PSH and lowered ephedrine requirement, indicating it may be a simple, cost-effective, and non-invasive intervention for reducing the need for vasopressor support in elective cesarean sections. Further research is warranted to standardize LE protocols and confirm its applicability across diverse clinical settings.Abstract EP104 Table 1Baseline characteristics of included studiesAbstract EP104 Figure 1PRISMA flow diagram of study screening and selectionAbstract EP104 Figure 2LE significantly reduced the risk of PSH compared to No LE