Abstract
BackgroundShivering is known to be a frequent complication in patients undergoing surgery under neuraxial anesthesia with incidence of 40–70%. Although many pharmacological agents have been used to treat or prevent postspinal anesthesia shivering (PSAS), the ideal treatment wasn’t found. This study evaluated the efficacy of paracetamol and dexamethasone to prevent PSAS in patients undergoing lower abdominal and lower limb surgeries.MethodsThree hundred patients scheduled for surgeries under spinal anesthesia (SA) were allocated into three equal groups to receive a single preoperative dose of oral paracetamol 1 g (P group), dexamethasone 8 mg intravenous infusion (IVI) in 100 ml normal saline (D group) or placebo (C group), 2 h preoperatively, in a randomized, double-blind trial. The primary endpoint was the incidence of clinically significant PSAS. Secondary endpoints included shivering score, the change in hemodynamics, adverse events (e.g., nausea, vomiting and pruritis) and patients` satisfaction.ResultsClinically significant PSAS was recorded as (15%) in P group, (40%) in D group and (77%) in C group (P < 0.001). The mean blood pressure values obtained over a 5-25 min observation period were significantly higher in the D group (P < 0.001). Core temperature 90 min after SA was significantly lower in the 3 groups compared to prespinal values (P < 0.001). Nausea, vomiting and pruritis were significantly higher in the C group (P < 0.001). P and D groups were superior to C group regarding the patients’ satisfaction score (P < 0.001).ConclusionParacetamol and dexamethasone were effective in prevention of PSAS in patients undergoing lower abdominal and lower limb surgeries compared to placebo controls.Trial registrationClinicalTrials.gov Identifier: NCT03679065 / Registered 20 September 2018 - Retrospectively registered, http://www.ClinicalTrial.gov.
Highlights
Shivering is known to be a frequent complication in patients undergoing surgery under neuraxial anesthesia with incidence of 40–70%
This study included 300 patients, of both sexes, aged 18–60 years, American Society of Anesthesiologists (ASA) I or II scheduled for elective lower abdominal or lower limb surgeries under spinal anesthesia and a written informed consent was obtained by every patient. “ The study protocol was performed in accordance to the ethical standards of the Declaration of Helsinki” [15]
Three hundred thirty-four patients were assessed for eligibility; of those 300 patients completed the study and were randomized (100 patients for each group) between the 3 groups and their data were included in the final analysis
Summary
Shivering is known to be a frequent complication in patients undergoing surgery under neuraxial anesthesia with incidence of 40–70%. Many pharmacological agents have been used to treat or prevent postspinal anesthesia shivering (PSAS), the ideal treatment wasn’t found. This study evaluated the efficacy of paraceta‐ mol and dexamethasone to prevent PSAS in patients undergoing lower abdominal and lower limb surgeries. Shivering is known to be a frequent complication in patients undergoing surgery under neuraxial anesthesia with incidence of 40–70% [1]. Postspinal anesthesia shivering (PSAS) is an involuntary, repetitive activity of skeletal muscles as a physiological response to core hypothermia to raise the metabolic heat production [3]. The mainstay of prophylaxis and treatment of PSAS remain pharmacological [1, 2, 4] due to inadequate control of central hypothermia by techniques based on physical principles (e.g., intravenous infusion (IVI) of warm fluids and forced air warmers) [5]. It appears logical to prevent PSAS rather than to treat it once it develops
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