Abstract
Background The frequency of shivering regarding regional anesthesia is 55%. Newer effective and tolerable options for postspinal anesthesia shivering (PSAS) prophylaxis are necessary to improve patients' quality of care. This research assessed the impact of preemptive mirtazapine versus preemptive dexamethasone to decrease frequency and severity of PSAS in gynecological procedures. Methods 300 patients booked for gynecological procedures under spinal anesthesia (SA) were randomly apportioned into three groups (100 each) to get one preemptive dose of 30 mg mirtazapine tablet (M group), 8 mg dexamethasone diluted in 100 ml of saline infusion (D group) or placebo (C group) two hours before surgery. Incidence of clinically significant PSAS was the primary outcome. Core temperature, shivering score, hemodynamics changes, adverse events, and patient satisfaction score were documented as secondary outcomes. Results Compared with C group, mirtazapine and dexamethasone decreased incidence of clinically significant shivering (74% vs. 16% and 31%, respectively; P < 0.001). M and D groups had less hypotensive episodes during 5–25 min after intrathecal injection (P < 0.001). 90 min after SA, tympanic temperatures were lower than baseline values in the three groups (P < 0.001). Pruritus, nausea, and vomiting were more often in C group (P < 0.001), whereas sedation was more frequent in M group (P < 0.001). C group had the lowest satisfaction scores (P < 0.001). Conclusion Prophylactic administration of mirtazapine or dexamethasone attenuated shivering with minimal hazards in patients scheduled for gynecological surgeries under spinal anesthesia with priority to mirtazapine. The trial is registered with NCT03675555.
Highlights
Spinal anesthesia (SA) is commonly practiced in gynecological surgeries
Several mechanisms are involved in the pathogenesis of postspinal anesthesia shivering (PSAS) including intraoperative heat loss and endogenous pyrogens
Patients may feel uncomfortable about the PSAS which may interfere with ECG monitoring, measurements of blood pressure, and readings of O2 saturation [4]
Summary
Spinal anesthesia (SA) is commonly practiced in gynecological surgeries. SA has many advantages, e.g., less intraoperative bleeding, less risk of venous thromboembolism, and better pain relief. E frequency of shivering regarding regional anesthesia is 55% [2]. SA influences temperature regulation through promotion of heat loss by vasodilation leading to trunk hypothermia and shivering [3, 4]. Several mechanisms are involved in the pathogenesis of postspinal anesthesia shivering (PSAS) including intraoperative heat loss and endogenous pyrogens. PSAS exerts metabolic effects and hemodynamic impacts including increased oxygen consumption, excess carbon dioxide production, high catecholamine levels in plasma, and increased cardiac output [2]. Newer effective and tolerable options for PSAS prophylaxis are necessary to improve patients’ quality of care. Mirtazapine has an antinociceptive effect [8] and decreases incidence of PDPH after SA [10]. Dexamethasone diminished the frequency of shivering following open-heart surgeries. Is research assessed the impact of preemptive mirtazapine versus preemptive dexamethasone to decrease the incidence and severity of PSAS in gynecological procedures
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