Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate in prevention of post spinal shivering in uroscopic surgery. (RCT)

Abstract

Background: Hypothermia and shivering are associated common complications after spinal anesthesia especially in uroscopic procedures when large amounts of cold intraluminal irrigating fluids are used. Among all adjuvants that have been used in literatures for shivering management, magnesium sulphate and dexmedetomidine were the most effective with least side effects. Our aim of the study is to compare the effect of intrathecal dexmedetomidine versus intrathecal magnesium sulfate in prevention of post spinal shivering. Methods: This prospective randomized, double-blinded controlled study was conducted at Kasr El-Aini Hospital from September 2017 till April 2018, on 105 patients scheduled for uroscopic surgeries. 105 patients were randomly allocated into three groups using computerized generated random tables, Group C (n=35) received 2.5 ml hyperbaric bupivacaine 0.5% (12.5 mg) +0.5 ml normal saline, Group M (n=35) received 2.5 ml hyperbaric bupivacaine 0.5% (12.5 mg) +25 mg magnesium sulfate and Group D (n=35) received 2.5 ml hyperbaric bupivacaine 0.5% (12.5mg) + 5 μg dexmedetomidine in 0.5 ml saline. Primary outcomes were the incidence and intensity of shivering. Secondary outcomes were incidence of hypothermia (Temp < 36° C), sedation, the use of pethidine to control shivering and complications as hypotension, bradycardia, nausea and vomiting. Results: C group showed statistically significant higher number of total patients who developed shivering (21), patients who developed grade IV shivering (20) and patients who needed pethidine (21) to treat shivering than M group (8,5,5) and D group (5,3,6) which were comparable to each other. Time needed to give pethidine after giving the block was similar in the three groups. Hypothermia didn’t occur in any patient in the three groups. The three groups were comparable regarding occurrence of nausea, vomiting, bradycardia & hypotension. All patients of C group, 32 patients in M group and 33 patients in D group had sedation score of 2. 3 patients in M group and 2 patients in D group had a sedation score of 3. Conclusions: intrathecal injection of dexmedetomidine and magnesium sulfate in spinal anesthesia were both effective in reducing the incidence of post spinal shivering. So, we encourage the use of magnesium sulphate being more physiological, readily available in most operating theatres and much cheaper than dexmedetomidine. Clinical trial registration ID: PACTR201801003001727

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 reported that Dex given intrathecally to patients undergoing major abdominal cancer surgery for postoperative analgesia could improve and prolong analgesia.…”