Evaluating Effect of Prophylactic Intravenous Dexamethasone in Post Spinal Shivering: A Single Centre Randomised Controlled Study

Abstract

Introduction: Shivering is a common side effect of central neuraxial anaesthesia. Intravenous pethidine is commonly used in reducing shivering but has been associated with significant opioid side effects. Dexamethasone as a powerful anti-inflammatory and analgesia agent is postulated to inhibit inflammatory mediators’ release thus inhibiting central thermoregulatory centre, potentially attenuating post spinal shivering. This double-blinded randomised controlled study was to determine the ability of intravenous dexamethasone in decreasing the incidence, severity and the need for treatment for post spinal shivering.
 Methods: We recruited 72 patients requiring spinal anaesthesia and randomised them to receive either dexamethasone 0.1 mg/kg (up to 8 mg) or normal saline (placebo). We observed their tympanic membrane temperatures, mean arterial pressures and shivering scores at regular intervals up to 2 hours post-spinal or till end of surgery (minimum 30 minutes post spinal).
 Results: Both groups showed consistent and comparable drop in tympanic membrane temperatures and mean arterial pressures after spinal anaesthesia, except at 15 minutes in which patients of dexamethasone group demonstrated significantly higher temperatures than saline group (p=0.04). There were also significantly less patients in the dexamethasone group reporting incidence of visible shivering as compared to the placebo group (p=0.003). No significant difference was seen in severity of shivering or usage of pethidine.
 Conclusion: Dexamethasone has the potential to mitigate the reduction in core body temperature, especially at 15 minutes post spinal. It can reduce the incidence of clinically significant visible grade of shivering post spinal.

The Effect of Prophylactic Steroids on Shivering in Adults Undergoing Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…While 2 studies evaluated the effect of prophylactic steroids on shivering in patients undergoing cardiac surgery, 7,27 19 studies were in patients undergoing various noncardiac surgeries, 15,26,28–39,42–46 and 4 studies were performed in women undergoing cesarean deliveries. 14,40,41,47 Perioperative shivering was the primary outcome in 21 studies.…”

“…48 Another study was excluded because the authors only evaluated the severity risk and not the risk of overall shivering. 49 While 2 studies evaluated the effect of prophylactic steroids on shivering in patients undergoing cardiac surgery, 7,27 19 studies were in patients undergoing various noncardiac surgeries, 15,26,[28][29][30][31][32][33][34][35][36][37][38][39][42][43][44][45][46] and 4 studies were performed in women undergoing cesarean deliveries. 14,40,41,47 Perioperative shivering was the primary outcome in 21 studies.…”

“…7,14,15,26,[29][30][31][33][34][35][36][37][38][39][40][41][42][43][45][46][47] However, a power analysis was reported in only 16 studies. 7,14,15,30,31,[33][34][35][36]38,40,41,43,[45][46][47] Dexamethasone was administered intravenously in 18 studies, 7,14,26,27,29,31,32,35,[37][38][39][41][42][43][44]…”

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

“…32 Another RCT study done in Malaysia showed that administration of dexamethasone is very effective in maintaining body temperature and the reductions of the incidence of shivering in patients undergoing surgery with spinal anesthesia. 33 The Role of Magnesium Sulphate in Prevention and Management of Post-Spinal Shivering Magnesium sulfate (MgSO 4 ) is an inorganic salt and non-competitive antagonist of N-methyl-D aspartate (NMDA) receptors with a good safety profile and neuroprotective properties under the condition of hypothermia. It plays a big role in suppressing the postoperative shivering through a central effect by reducing the shivering threshold and additionally blocks NMDA receptors, decreasing norepinephrine and 5-HT receptor which both play a role in thermoregulation.…”

Intraoperative phenylephrine infusion to reduce perioperative shivering in lower segment caesarean section: A randomised controlled study

“…[ 1 ] Studies have demonstrated that the incidence of shivering associated with central neuraxial block is at the range 40% to 70%. [ 2 , 3 ] The incidence of shivering in obstetric patients with neuraxial blockade is between 40% to 60%. [ 4 , 5 ]…”