Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery; (RCT)

Abstract

BackgroundHypothermia and shivering are common complications after spinal anaesthesia, especially after uroscopic procedures in which large amounts of cold intraluminal irrigation fluids are used. Magnesium sulfate and dexmedetomidine are the most effective adjuvants with the least side effects. The aim of this study was to compare the effects of intrathecal dexmedetomidine versus intrathecal magnesium sulfate on the prevention of post-spinal anaesthesia shivering.MethodsThis prospective randomized, double-blinded controlled study included 105 patients who were scheduled for uroscopic surgery at the Kasr El-Aini Hospital. The patients were randomly allocated into three groups. Group C (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 0.5 ml of normal saline, Group M (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 25 mg of magnesium sulfate in 0.5 ml saline, and Group D (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 5 μg of dexmedetomidine in 0.5 ml saline. The primary outcomes were the incidence and intensity of shivering. The secondary outcomes were the incidence of hypothermia, sedation, the use of meperidine to control shivering and complications.ResultsGroup C had significantly higher proportions of patients who developed shivering (21), developed grade IV shivering (20) and required meperidine (21) to treat shivering than group M (8,5,5) and group D (5,3,6), which were comparable to each other.The time between block administration and meperidine administration was similar among the three groups. Hypothermia did not occur in any of the patients.The three groups were comparable regarding the occurrence of nausea, vomiting, bradycardia and hypotension. All the patients in group C, 32 patients in group M and 33 patients in group D had a sedation score of 2. Three patients in group M and 2 patients in group D had a sedation score of 3.ConclusionsIntrathecal injections of both dexmedetomidine and magnesium sulfate were effective in reducing the incidence of post-spinal anaesthesia shivering. Therefore, we encourage the use of magnesium sulfate, as it is more physiologically available, more readily available in most operating theatres and much less expensive than dexmedetomidine.Trial registrationClinical trial registration ID: Pan African Clinical Trial Registry (PACTR) Trial Number PACTR201801003001727; January 2018, “retrospectively registered”.

5-HT3receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials

“…39 During spinal anaesthesia, vasodilatation and redistribution of the core temperature are restricted to the lower body below the level of the block, while vasoconstriction and shivering are restricted to the upper body. 40 Voronova et al 41 suggested that the activation of central 5-HT3 receptors is more effective in hypothermia induction due to a marked decrease in thermogenesis and increased heat loss, indicating that 5-HT3-associated pathways may play an important role in controlling shivering. The mechanism of 5-HT3 receptor antagonists to prevent Open access chills might be related to the inhibition of neurotransmission required for hypothalamic temperature regulation .…”

Intrathecal dexmedetomidine improves epidural labor analgesia effects: a randomized controlled trial

“…Sufentanil has been used as a local anesthetic in spinal blocks for labor analgesia in many previous studies; 4 therefore, intrathecal injection of sufentanil combined with epidural ropivacaine and sufentanil was the positive control in the present study. Dex has also been reported to maintain stability, relieve pain, prevent chills without respiratory depression when used as an intrathecal drug, 20 , 21 and improve intrathecal and epidural blocks. 22 , 23 Mohamed et al.…”

Application of Different Doses of Dexmedetomidine Combined with General Anesthesia in Anesthesia of Patients with Traumatic Tibiofibular Fractures and Its Effect on the Incidence of Adverse Reactions

“…(2) There is a certain critical value for the sedation effect of dexmedetomidine in sleep time of nonrapid eye movements, and a higher dose exceeding the critical value may lead to excess sedation, thus triggering symptoms such as delayed awakening, hypothermia, and muscle vibration. (3) Low-dose dexmedetomidine has insignificant effect on protecting brain, and both medium and large doses can protect brain function, whereas excessive doses cannot improve the effect of brain protection, but triggers intraoperative hypotension [ 23 – 25 ].…”