Abstract
BackgroundRegional anesthesia could affect the homeostatic system functions resulting frequently in perioperative hypothermia and consequently shivering. The objective of this trial was to evaluate the efficacy of dexmedetomidine and ondansetron to reduce the incidence and severity of shivering after intrathecal blocks.MethodsThis randomized placebo-controlled trial included 120 patients allocated equally in three groups. All patients were anesthetized by standard intrathecal blocks for surgical procedure at lower half of the body and received one of the study drugs intravenously (IV) according to the group assignments. Group S patients (placebo) were administered saline, Group O (ondansetron) were given 8 mg ondansetron, and Group D (dexmedetomidine) were given 1 μg/kg of dexmedetomidine. Shivering incidence and scores, sedation scores, core body temperature, hemodynamic variables, and incidence of complications (nausea, vomiting, hypotension, bradycardia, over-sedation, and desaturation) were recorded.ResultsThe incidence and 95% confidence interval (95% CI) of shivering in group S 57.5% (42.18–72.82%) was significantly higher than that of both group O 17.5% (5.73–29.27%), P < 0.001 and group D 27.5% (13.66–41.34%), P = 0.012. However, the difference in the incidence of shivering between group O and group D was comparable, P = 0.425. The sedation scores were significantly higher in group D than those of both group S and group O, P < 0.001. Sedation scores between group S and group O were comparable, P = 0.19. Incidences of adverse effects were comparable between the three groups.ConclusionProphylactic administrations of dexmedetomidine or ondansetron efficiently decrease the incidence and severity of shivering after spinal anesthesia as compared to placebo without significant difference between their efficacies when compared to each other.Trial registrationPan African Clinical Trial Registry (PACTR) under trial number (PACTR201710002706318). 18-10-2017. ‘retrospectively registered’.
Highlights
Regional anesthesia could affect the homeostatic system functions resulting frequently in perioperative hypothermia and shivering
The local ethical committee approval was obtained from Fayoum University Hospitals (R 64) and the study protocol was registered in Pan African Clinical Trial Registry (PACTR) under trial number (PACTR201710002706318)
Each participant was informed about the study protocol in details and complete written informed consents were signed before enrollment in the study
Summary
Regional anesthesia could affect the homeostatic system functions resulting frequently in perioperative hypothermia and shivering. Temperatures greater than that set-point will initiate reactions to lower the body temperature, while temperatures lesser than that set-point will propagate responses to increase the body temperature [2, 3] Both regional and general anesthesia are recognized to disturb the competence of that homeostatic system and may end in various grades of hypothermia. Intrathecal block drops this set-point by 0.5 °C leading to vasoconstriction and shivering above the level of the block [4]. The efficacy and safety findings remain unclear or even inconsistent [10]
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