Assessment of Diclofenac Sodium Infusion for Management of Post-Spinal Shivering

Abstract

Background: shivering is a common problem faced by an anesthesiologist during intraoperative as well as in postoperative period. It is a frequent, unpleasant, and undesirable complication occurring after sub-arachnoid block (SAB), secondary to vasodilatation as a result of sympathetic blockade. The incidence of shivering has been reported to be about 36-85% after spinal anesthesia. The present study was designed to compare the efficacy of diclofenac sodium and pethidine on reducing postoperative shivering following sub-arachnoid block. Objectives: the aim of this study was to investigate the ability of intravenous infusion of diclofenac sodium (1mg/kg maximally 75mg) to treat established post-spinal shivering. Patients and Methods: after approval from departmental ethics committee in Ain shams university and written informed consent from the patient, a randomized study was conducted on ninety adult patients with American society of anesthesiologists (ASA) physical status I, II and III aged from 18 to 65 years. The study was conducted from September 2017 to February 2018. The study was a randomized, prospective, double-blind, placebo-controlled study. All patients were informed about the study design and objectives as well as tools and techniques. Informed consent was signed by every patient prior to inclusion in the study. Results: after approval of the department of anesthesiology, intensive care and pain management at Ain Shams University ethical committee, this randomized study was conducted on ninety patients who were scheduled to have surgery with spinal anesthesia. The design of the study included three groups, each constitutes of 30 patients (n= 30). Conclusion: the data showed that pethidine infusion was more effective than diclofenac sodium infusion in management of shivering after spinal anesthesia. However diclofenac sodium was better than placebo in non-significant way. Keywords: Diclofenac Sodium Infusion, Post-Spinal Shivering, pethidine infusion INTRODUCTION Shivering is a frequently occurring post-anesthesia complication. It occurs after both general and regional anesthesia. It is estimated to follow more than 40% of all cases receive anesthesia. Shivering is defined as involuntary, spontaneous, oscillatory muscular activity. It is one of main cause of patient discomfort in the immediate postoperative period. Oxygen consumption increases with the intense of shivering. It may resemble a mild exercise but in some severe cases oxygen consumption may rise to 600%. Post-anesthesia shivering may be caused by different factors. It is considered a physiological response to core hypothermia that accompanies anesthesia. Core hypothermia is attributed mainly to redistribution of warm core blood to cold peripheral compartment after peripheral vasodilatation that starts immediately after induction of anesthesia. Other factors help hypothermia include cold room temperature and intravenous fluids used intraoperatively. Other factors that may lead to shivering include transfusion reactions, bacteremia and sepsis and drug reaction(1). The incidence of shivering has been reported to be about 36-85% after SAB. Shivering has detrimental effects like interference in monitoring of pulse rate, blood-pressure (BP), and ECG, increase in oxygen consumption, catecholamine secretion, carbon dioxide production, metabolic rate increase by 400%, increase intraocular pressure (IOP), Intra-cranial pressure (ICP), and lactic acid