Effects of Fentanyl and Morphine on Shivering During Spinal Anesthesia in Patients Undergoing Endovenous Ablation of Varicose Veins

Önk, Didem; Ayazoğlu, Tülin Akarsu; Kuyrukluyıldız, Ufuk; Aksüt, Mehmet; Bedir, Zehra; Küpeli, İlke; Onk, Oruç Alper; Alagöl, Ayşin

doi:10.12659/msm.897256

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Currently, postoperative shivering after spinal anesthesia is still a problem that must be prevented. [23] In our study, when the patient records in the recovery unit in the postoperative period were assessed, the incidence of shivering was found to be significantly higher in Group S than Group F. Urinary retention occurs after spinal anesthesia, particularly in patients with a high level of sensory block need. [24] In our study, urinary retention was defined as the inability to urinate, although the patient needed and consecutively attempted to urinate.…”

Section: Discussionmentioning

confidence: 49%

Femoral nerve block versus spinal anesthesia in the treatment of saphenous vein ablation

Kaçmaz¹

2021

Turk J Vasc Surg

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Objectives: This study aims to compare the effects of spinal anesthesia and femoral nerve block and to determine the optimal anesthesia method for embolization of vena saphena magna.Patients and methods: Between December 2019 and March 2021, a total of 160 patients (89 males, 71 females; mean age: 44.4 years; range, 18 to 69 years) who were diagnosed with varicose veins and hospitalized for surgery in our cardiovascular surgery clinic were included. The patients were divided into two groups. The first group (Group S, n=80) underwent spinal anesthesia and the second group (Group F, n=80) underwent femoral nerve block for the surgical operation. Results:The mean arterial pressures (MAPs) were significantly lower in Group S compared to Group F. The mean time until surgery was earlier in Group S (4.57±1.0 min vs. 9.9±3.4 min, respectively; p<0.01). The mean duration of motor block was longer in Group S (3.4±1.1 h vs. 2.7±0.8 h, respectively; p<0.05). The mean duration of mobilization was statistically significantly shorter in Group F (6.1±1.7 h vs. 5.2±1.4, respectively; p<0.05). The development of urinary retention was statistically significantly higher in Group S (p<0.05). The mean patient satisfaction score after discharge was higher in Group F (3.5±0.5 vs. 2.9±0.8, respectively; p<0.05). The incidence of postoperative shivering was statistically significantly higher in Group S (p<0.05). Conclusion:Femoral nerve block, which is used for intraoperative anesthesia during the procedure of endovenous laser ablation, can be preferred as an alternative method to spinal anesthesia.

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Section: Discussionmentioning

confidence: 49%

Femoral nerve block versus spinal anesthesia in the treatment of saphenous vein ablation

Kaçmaz¹

2021

Turk J Vasc Surg

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“…Body temperature is regulated by the anterior hypothalamus when the peripheral temperature reaches a certain threshold. This regulation is mainly achieved by reflex activity when the temperature exceeds or falls below a certain level 4,5 . It is well known that both general and regional anesthesia affects the homeostatic system.…”

Section: Introductionmentioning

confidence: 99%

Comparative Study between Dexmedetomidine and Nalbuphine for prevention of post spinal shivering in Obstetrics cases- A randomized controlled trial

Kawsar

Das

Banik

et al. 2022

j Bangladesh Soc Anaesthesiologists

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Background: Shivering is a physiological response to core hypothermia in an attempt to raise themetabolic heat production. The main causes of intra/post-operative shivering are temperature loss,increased sympathetic tone, pain, and systemic release of pyrogens. Spinal anaesthesia significantlyimpairs the thermoregulation system by inhibiting tonic vasoconstriction, which plays a significant rolein temperature regulation. It also causes a redistribution of core heat from the trunk (below the blocklevel) to the peripheral tissues. These factors predispose patients to hypothermia and shivering. Severalpharmacological agents are used for control of Post spinal shivering. Nalbuphine has become afavoured and commonly used drug for post-spinal shivering. However, it has many adverse effects likenausea, vomiting, dizziness etc. Dexmedetomidine is another agent which has gained popularity duringthe last few years. Dexmedetomidine is an α2-adrenergic receptor agonist, has been used as a sedativeagent and is documented to increase the shivering threshold. Objectives: To assess the superiority of Dexmedetomidine over Nalbuphine in prevention of post spinalshivering. Materials & method: This prospective, randomized clinical trial was conducted in Department ofAnaesthesia, Analgesia, Palliative and Intensive Care Medicine, Dhaka Medical College Hospital, from18th October 2019 to 17th April 2020. Total 120 patients were selected and allocated into two groups,group N (Nalbuphine) and group D (Dexmedetomidine). Patients of Group N was given intravenousNalbuphine 0.07 mg/kg mixed with 0.9% normal saline to a volume of 10ml. Patients of Group D wasgiven intravenous Dexmedetomidine hydrochloride 1 μg/kg mixed with 0.9% normal saline to a volumeof 10ml. Then shivering grade and haemodynamic status were recorded at different follow-up time andcompared between groups. Result: Majority of the patients i.e. 58.33% (n=70) were between 25-30 years, mean age was found to26.7±8.4 years and 26.7±8.4 years in Group D & N respectively. The heart rate after 5 min (56, 62beat/min respectively), after 10 min (58, 68 beat/min respectively) and 15 min (63, 72 beat/min respectively)after of anaesthesia were statistically significant. Shivering grade 3 or 4 was existed in bothgroups, but more in group N. Rescue medication for shivering (Inj. Pethedine 25 mg) requirement washigher in Group-N & difference was statistically significant. Shivering was controlled within 15 minutein maximum 13(21.66%) of patients in group D. Comparison of sedation, 45 minute after mean sedationscore was found 2.03±0.07 in group D, but in group N score is reduced and found 1.43±0.127. Meansedation score difference was statistically significant (p<0.05) between two groups. Conclusion: Post spinal shivering is very distressing for patients and may induce a variety of complications.Present study concluded that Dexmedetomidine was more effective compared to Nalbuphineinattenuating the post spinal shivering. JBSA 2022; 35 (2) : 3-11

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“…Apart from the non-pharmacological methods, many drugs have also been used for the prevention and management of shivering which includes but are not limited to pethidine, clonidine, dexmedetomidine, ondansetron, fentanyl, granisetron, and butorphanol. [11][12][13] But because of the safety, cost, and unavailability of those interventions in limited-resource settings, it forces us to use an alternative method like pre-warming the patients for 15 minutes, by using a cotton blanket, gown warming, administering warm fluids, low dose ketamine, tramadol, dexamethasone, and magnesium sulfate serves as prevention and management based on the available evidence. 14 As a result, using these alternative medications help us to reduce the unnecessary cost to hospital and patients, and minimize the unwanted side effect of mentioned drugs and it also paves the way for further researches to be done in this regard.…”

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confidence: 99%

Evidence-Based Guideline on Prevention and Management of Shivering After Spinal Anesthesia in Resource-Limited Settings: Review Article

Amsalu¹,

Zemedkun²,

Regasa³

et al. 2022

IJGM

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Background: Perioperative shivering is a common problem faced in anesthesia practice. Unless it is properly managed and prevented, it causes discomfort and devastating problems, especially in patients with cardiorespiratory problems. Surgery, anesthesia, exposure of skin in a cool operating theater, and administration of unwarmed fluids are some of the major causes for the development of shivering among surgical patients. Currently, a variety of non-pharmacological and pharmacological techniques are available to prevent and manage this problem. The available options to prevent and treat shivering include but are not limited to pre-warming the patient for 15 minutes before anesthesia administration, administration of low dose ketamine, dexamethasone, pethidine, clonidine, dexmedetomidine, tramadol, and magnesium sulfate. Objective: To develop evidence-based recommendations for the prevention and management of shivering after spinal anesthesia in a resource-limited settings. Methods: The kinds of literature are searched from Google Scholar, PubMed, Cochrane library, and HINARI databases to get access to current and update evidence on the prevention and management of shivering after spinal anesthesia. The keywords for the literature search were (shivering or prevention) AND (shivering or management) AND (anesthesia or shivering). Conclusion: Pre-warming the patient with cotton, blanket, gown warming, and administering warm IV fluid 15 minutes before spinal anesthesia are possible non-pharmacologic options for the prevention of shivering. Furthermore, pharmacological medications like low dose ketamine, dexamethasone, magnesium sulfate, ad tramadol can be used as alternative options for the prevention and management strategies for shivering of different degrees in resource-limited areas.

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Effects of Fentanyl and Morphine on Shivering During Spinal Anesthesia in Patients Undergoing Endovenous Ablation of Varicose Veins

Cited by 8 publications

References 15 publications

Femoral nerve block versus spinal anesthesia in the treatment of saphenous vein ablation

Femoral nerve block versus spinal anesthesia in the treatment of saphenous vein ablation

Comparative Study between Dexmedetomidine and Nalbuphine for prevention of post spinal shivering in Obstetrics cases- A randomized controlled trial

Evidence-Based Guideline on Prevention and Management of Shivering After Spinal Anesthesia in Resource-Limited Settings: Review Article

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