Intrathecal dexamethasone vs. meperidine for prevention of shivering during transurethral prostatectomy: a randomized controlled trial

Moeen, Seham M.; Moeen, Ahmed M

doi:10.1111/aas.12920

Cited by 36 publications

(56 citation statements)

References 18 publications

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“…These factors may add to those patients in dexamethasone group reported higher satisfaction scores. Patients in dexamethasone group also experienced less hemodynamic events and no sedation (Moeen and Moeen, 2017).…”

Section: Discussionmentioning

confidence: 84%

Addition of intrathecal dexamethasone to bupivacaine for spinal anesthesia in cesarean section

El-Shourbagy

Mammdouh

Shawky

et al. 2019

Evidence Based Women's Health Journal

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Background: Post-caesarean section pain is an important issue in obstetrics. Several studies have shown the importance of adequate postoperative analgesia on mobilization, rehabilitation and decreasing the length of hospital stay. Large amounts of opioid analgesic drugs are often required in the management of intense post-operative pain. However, this option is associated with many side effects. Objective: The aim of the study was to assess the efficacy of adding dexamethasone to bupivacaine for spinal anesthesia in prolonging the duration and anesthetic effect in women undergoing cesarean section. Patients and Methods: Populations of the study were comprised of 100 pregnant full term female planed for cesarean section. All patients had cesarean section under spinal anesthesia. Pain was assessed using 10 cm visual analogue scale (VAS) after 0, 15, 30 min and 2, 4, 6 hours post-operatively and until the mother asked for an analgesic. The duration of sensory block as well as postoperative analgesia were calculated. The study population had been randomized into 2 groups: The 1 st group C (n=50 women) included 50 women receiving intrathecal dexamethasone added to bupivacaine. The 2 nd group B (n=50 women) included 50 women receiving placebo which was added to intrathecal bupivacaine. Results: This study has shown that the addition of intrathecal dexamethasone to bupivacaine significantly improved the duration of sensory block in spinal anesthesia as the duration of sensory block in the study group was 122 + 7.9 minutes while in the control group it was 91.8 + 10.8 minutes and p<0.001. Also, receiving time to VAS >6 and the first analgesic dose prescription in the case group was significantly longer than that in the control group (P<0.001) as the pain free period in the study group was 434.3 + 43.8 minutes while in the control group it was 215.3 + 40.3minutes. Also, the motor block duration in the study group was significantly prolonged when compared with control group (p<0.01).There was no difference in onset time between the two groups and the addition of dexamethasone cause no complications. Conclusion: This study has shown that the addition of intrathecal dexamethasone to bupivacaine significantly improved the duration of sensory block in spinal anesthesia without any changes in onset time and complications, and has increased the pain free period statistically. Recommendations: Further studies are needed to evaluate the optimal dose of dexamethasone to be used in spinal anesthesia.

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Section: Discussionmentioning

confidence: 84%

Addition of intrathecal dexamethasone to bupivacaine for spinal anesthesia in cesarean section

El-Shourbagy

Mammdouh

Shawky

et al. 2019

Evidence Based Women's Health Journal

View full text Add to dashboard Cite

show abstract

“…Moreover, ondansetron might be responsible for lower spinal block level and early recovery from spinal anesthesia. (25) DEX also has a bundle of collateral bene ts in spinal anesthesia having anti-emetic (7) and anti-shivering (8) effects. Adding to this, it was proposed to increase the duration of sensory block in spinal anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Dexamethasone (DEX) -a synthetic glucocorticoid-is used to abolish post-spinal nausea and vomiting (7) or shivering (8) , and may increase the duration of sensory block (9,10) . Dexamethasone increased tissue peripheral vascular resistance (PVR) in rats (11) and humans by a variety of mechanisms (12) , and there is a plethora of studies con rming its role in maintaining the integrity of circulation in situations of intense vasodilatation like septic shock (13) and anaphylaxis (14) .…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone Blunts Post-Spinal Hypotension in Geriatric Patients Undergoing Orthopedic Surgery: A Double Blind, Placebo-Controlled Study

Ashoor

Hussien

Anis

et al. 2020

Preprint

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Background. Post-spinal hypotension in elderly is challenging, correction by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Dexamethasone is used to treat conditions manifested by decrease of peripheral vascular resistance; we were the first to test the hypothesis of its role in preventing or decreasing the incidence of post-spinal hypotension.Methods. 110 patients aged 60 years or more were recruited in the study, 55 in the Dexamethasone group (D group) were given 8 mg Dexamethasone 2 hours preoperatively, and 55 were given placebo (C group).Variations in blood pressure and heart rate and need of vasoconstrictors and/or atropine following spinal anesthesia (SA) was done. SA was done by subarachnoid injection of 3 ml of hyperbaric bupivacaine.Results. Demographic data and the quality of sensory and motor block were comparable between groups. At 5, 10 minutes; systolic, diastolic and, mean arterial pressures were significantly higher in group D. At 20 minutes readings were non significant between groups. Heart rate changes didn’t show any significance. Need for ephedrine was less in group D, side effects were less in the D group. Conclusion. Dexamethasone may attenuate post-spinal hypotension in elderly, with a favorable response against nausea, vomiting and shivering that associate spinal anesthesia.

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“…Besides its well-known advantages, SA has an additional one in uroscopic surgeries especially procedures that need intralumnal fluids irrigation such as TURP, as it allows early detection of complications as TURP syndrome in conscious patients (1). However, SA is not a complication free technique; Shivering is one of the common complications of spinal anesthesia with an incidence reach 40-60% of patients undergoing spinal anesthesia (5).…”

Section: Discussionmentioning

confidence: 99%

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

Omar

adel

Hassan

et al. 2019

Preprint

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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. Magnesium sulphate and dexmedetomidine are the most effective adjuvants 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 on 105 patients scheduled for uroscopic surgeries. 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 in 0.5 ml saline 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 meperidine to control shivering and complications, 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 meperidine (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 meperidine 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 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.

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Intrathecal dexamethasone vs. meperidine for prevention of shivering during transurethral prostatectomy: a randomized controlled trial

Abstract: Intrathecal dexamethasone was as effective as intrathecal meperidine in attenuation of shivering compared to placebo in patients scheduled for prostate surgery under spinal anesthesia with less adverse events.

Cited by 36 publications

References 18 publications

Addition of intrathecal dexamethasone to bupivacaine for spinal anesthesia in cesarean section

Addition of intrathecal dexamethasone to bupivacaine for spinal anesthesia in cesarean section

Dexamethasone Blunts Post-Spinal Hypotension in Geriatric Patients Undergoing Orthopedic Surgery: A Double Blind, Placebo-Controlled Study

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

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