Abstract
Background: Shivering occurs frequently during the perioperative period. A prospective, randomized, double-blind study was done to compare between intrathecal dexmedetomidine (5mcg) and intrathecal meperidine (0.2mg/kg) for decreasing the incidence and intensity of shivering after spinal anesthesia for lower abdominal operations. Methods: Seventy five patients scheduled for lower abdominal operations under spinal anesthesia were randomly allocated to three groups. Spinal anesthesia consisted of 12.5 mg hyperbaric bupivacaine 0.5% in addition to dexmedetomidine (5mcg) (group D) or meperidine (0.2 mg/kg) (group M) or, normal saline (group S). Different parameters, including sublingual temperature, sensory block, motor block, incidence and intensity of shivering, blood pressure, heart rate, pruritus, nausea, and vomiting was performed at 10 minute intervals. Statistical analysis was carried out using statistical package for social sciences (SPSS) version 15.0 for windows and employing ANOVA and chi-square test with post-hoc comparisons with Bonferroni’s correction. Results: Hypothermia was recorded in 17 patients (68%) in group D, 16 patients (64%) in group M and 18 patients (72%) in group S, while shivering developed in 5 patients (20%) in group D, 6 patients (24%) in group M and 23 patients (92%) in group S, however, pruritus, nausea and vomiting was more common in the meperidine group compared to the other two groups. Conclusion: Intrathecal dexmedetomidine and meperidine lowered the incidence of shivering and increased duration of sensory and motor block during lower abdominal operations. Intrathecal meperidine caused more pruritus, nausea and vomiting than intrathecal dexmedetomidine.
Highlights
Shivering is a protective mechanism by which heat production occurs, by vigorous involuntary muscle activity, to compensate for the decreased core temperature in a normal healthy living body
Spinal anesthesia impairs the thermoregulation system, it inhibits the tonic vasoconstriction, which plays a significant role in temperature regulation [2]
Dexmedetomidine is a highly selective alpha-2-adrenoceptor agonist with potent effects on the central nervous system and it was used for prevention and treatment of shivering associated with general or spinal anesthesia [68]
Summary
Shivering is a protective mechanism by which heat production occurs, by vigorous involuntary muscle activity, to compensate for the decreased core temperature in a normal healthy living body. Spinal anesthesia causes redistribution of core heat from the trunk (below the block level) to the peripheral tissues. These two effects predispose patients to hypothermia and shivering [3]. Adding a small dose of meperidine to the intrathecal mixture during spinal anesthesia reduces the incidence and severity of shivering. The aim of this study was to compare between intrathecal dexmedetomidine and intrathecal meperidine on the incidence and severity of shivering following spinal anesthesia. A prospective, randomized, double-blind study was done to compare between intrathecal dexmedetomidine (5mcg) and intrathecal meperidine (0.2mg/kg) for decreasing the incidence and intensity of shivering after spinal anesthesia for lower abdominal operations
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