Efficacy of intrathecal dexmedetomidine in prevention of shivering in patients undergoing transurethral prostatectomy: A randomized controlled trial

Abstract

Background: Shivering is a frequent complication following spinal anesthesia (SA). It is more common in transurethral resection of the prostate (TURP) that may be due to absorption of large amount of irrigating fluids. We aimed to investigate the role of intrathecal dexmedetomidine in attenuation and prevention of shivering in patients undergoing TURP under SA. Methods: In a randomized, controlled trial, eighty patients were scheduled for elective TURP under SA. Patients were randomly allocated into two groups: control group (group C): patients received 2.5 ml of hyperbaric bupivacaine 0.5% plus 0.5 ml of normal saline and dexmedetomidine group (group D); patients received 2.5 ml of hyperbaric bupivacaine 0.5%, plus 10 lg dexmedetomidine in 0.5 ml of normal saline. Hemodynamic parameters, shivering score and any adverse effects were recorded. Results: The incidence of shivering was significantly reduced in group D, 6/40 patients (15%) compared with 23/40 patients (57%) in group C (P < 0.001). The frequency of bradycardia, hypotension, number of patients treated with meperidine and ephedrine were significantly higher in group D compared with group C (P = 0.048, P = 0.043, P = 0.011, P = 0.043) respectively. There was insignificant difference in the incidence of nausea, vomiting and TUR syndrome in patients in both groups (p > 0.05). Conclusion: Our results suggest that the use of 10 lg intrathecal dexmedetomidine in patients undergoing TURP has a noticeable control of shivering even in occurrence of tolerable side effects.

Effects of intrathecal dexmedetomidine on shivering after spinal anesthesia for cesarean section: a double-blind randomized clinical trial

“…With regard to shivering, the results of Moawad and Elawdy’s13 study are in agreement with the current study. The lower incidence of shivering compared with our study may relate to the higher dose of dexmedetomidine (10 μg versus 5 μg).…”

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

“…The secondary outcomes were the incidence of hypothermia, sedation, the use of meperidine to control shivering and complications. Results: Group 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.…”

“…Dexmedetomidine is a highly selective alpha-2-adrenoreceptor agonist with potent effects on the central nervous system, decreasing the sympathetic tone (5). It has been effectively used intravenously for the treatment (6-10) and prevention (11)(12)(13)(14) of shivering following SA without any major adverse effects in several studies.…”

Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

“…Side effects were reported in 15 studies, comprising neurological complications [24, 25, 28, 30], respiratory depression [22, 24–26, 28–30, 38, 44, 45], bradycardia [22–30, 36, 38, 44, 45], hypotension [22–27, 29, 30, 36, 38, 44, 45], nausea/vomiting [22–30, 36–39, 44, 45]. None of the studies reported mortality and major cardiovascular complications, such as non-fatal myocardial infarction, stroke, or cardiac arrest.…”

“…Dexmedetomidine, a highly lipophilic anesthetic [47], demonstrates almost 8- 10times higher affinity to α2-ARs than clonidine [48]. When administered as a neuraxial adjuvant, dexmedetomidine can quickly bind to dorsal horn of the spinal cord α2-ARs, subsequently to inhibit the spontaneous firing rate of neurons [49] and sympathetic tone [29]. However, mechanisms of hypothermia and shivering may differ in parturients.…”