The intravenous injection of pethidine and dexmedetomidine in the prevention of cesarean postoperative shivering under spinal anesthesia: A double-blind clinical trial

Document Type : Original Article

Authors

1 Medical Student, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Associate professor, Department of Anesthesiology and Critical Care, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Introduction: Postoperative shivering is a common complication in pregnant women undergoing cesarean section with spinal anesthesia, and since no ideal method has been proposed to prevent this complication, the present study was performed aimed to compare the effect of intravenous injection of pethidine and dexmedetomidine in prevention of shivering after cesarean section under spinal anesthesia.
Methods: This double-blind randomized clinical trial study was performed in 2019-2020 on 90 women candidates for cesarean section with spinal anesthesia in Alzahra and Shahid Beheshti hospitals of Isfahan. The subjects were randomly assigned to three groups (n=30 in each group). The first group received 0.25 mg pethidine, the second group 0.1 μg/kg dexmedetomidine and the third group received the same volume of normal saline. The drugs were injected intravenously immediately after fetal removal and umbilical cord clamp, and the incidence and severity of shivering in recovery were evaluated. Data were analyzed by SPSS statistical software (version 25) and One-way analysis of variance, analysis of variance with repeated observations, Chi-square and Wilcoxon tests. P< 0.05 was considered statistically significant.
Results: There was a significant difference between the three groups in the incidence of shivering (P <0.001). In examining the frequency of shivering intensity in the three studied groups, the intensity of shivering in the pethidine group was less than that of dexmedetomidine, especially in grades 3 and 4, and the intensity of shivering in the two intervention groups was less than the control group (p=0.002).
Conclusion: The use of both pethidine and dexmedetomidine reduces the incidence of shivering after cesarean section. Since the side effects of dexmedetomidine are less than pethidine and also due to the limitation of pethidine consumption in some patients, it seems that the use of this drug is preferable to pethidine.

Keywords

References

  1. Lopez MB. Postanaesthetic shivering–from pathophysiology to prevention. Romanian journal of anaesthesia and intensive care 2018; 25(1):73.
  2. Liu J, Huang S, Sun S, Sun X, Wang T. Comparison of nalbuphine, ondansetron and placebo for the prevention of shivering after spinal anaesthesia for urgent caesarean delivery: a randomised double-blind controlled clinical trial. International Journal of Obstetric Anesthesia 2020; 42:39-46.
  3. Jain A, Gray M, Slisz S, Haymore J, Badjatia N, Kulstad E. Shivering treatments for targeted temperature management: a review. The Journal of Neuroscience Nursing 2018; 50(2):63.
  4. Shukla U, Malhotra K, Prabhakar T. A comparative study of the effect of clonidine and tramadol on post-spinal anaesthesia shivering. Indian journal of anaesthesia 2011; 55(3):242.
  5. Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian journal of anaesthesia 2011; 55(2):116.
  6. Alipour M, Sharifian A, Dastkhosh A. Effects of magnesium sulfate on prevention of shivering during spinal anesthesia in cesarean section. Iran J Obstet Gynecol Infertil 2013; 16(79):1-9.
  7. Wang N, Wang R, Chen Y, Zhang W, Wang J. Pethidine versus tramadol for shivering treatment after spinal anaesthesia: a meta-analysis of randomized controlled trials. Indian Journal of Surgery 2021; 83(5):1121-6.
  8. Bajwa SJ, Gupta S, Kaur J, Singh A, Parmar SS. Reduction in the incidence of shivering with perioperative dexmedetomidine: A randomized prospective study. Journal of anaesthesiology, clinical pharmacology 2012; 28(1):86.
  9. Jiang J, Shen H, Zhang J, Wu Z, Shao X, Cui J, et al. Comparative Study of the Adverse Events Associated With Adjuvant Use of Dexmedetomidine and Clonidine in Local Anesthesia. Frontiers in medicine 2021: 925.
  10. Karaman S, Günüşen I, Ceylan MA, Karaman Y, Çetin EN, Derbent A, et al. Dexmedetomidine infusion prevents postoperative shivering in patients undergoing gynecologic laparoscopic surgery. Turkish Journal of Medical Sciences 2013; 43(2):232-7.
  11. Qiu J, Luo Z. The comparison of dexmedetomidine and ketamine for pediatric dental surgery: A meta-analysis of randomized controlled studies. Medicine 2019; 98(17).
  12. Rastegarian A, Sadeghi SE, Damshenas MH, Ghanei M, Kalani N, Hemati H, et al. Effects of administration of dexmedetomidine with intrathecal bupivacaine on analgesia after femoral and tibia orthopedic surgery: A double-blind randomized clinical trial study. Koomesh 2020; 22(4):678-85.
  13. Kim YS, Kim YI, Seo KH, Kang HR. Optimal dose of prophylactic dexmedetomidine for preventing postoperative shivering. International journal of medical sciences 2013; 10(10):1327-32.
  14. Fern L, Misiran K. Comparison of dexmedetomidine, pethidine and tramadol in the treatment of post-neuraxial anaesthesia shivering. Southern African Journal of Anaesthesia and Analgesia 2015; 21(1):21-6.
  15. Mittal G, Gupta K, Katyal S, Kaushal S. Randomised double-blind comparative study of dexmedetomidine and tramadol for post-spinal anaesthesia shivering. Indian journal of anaesthesia 2014; 58(3):257.
  16. Usta B, Gozdemir M, Demircioglu RI, Muslu B, Sert H, Yaldız A. Dexmedetomidine for the prevention of shivering during spinal anesthesia. Clinics 2011; 66(7):1187-91.
  17. Elvan EG, Öç B, Uzun ŞE, Karabulut ER, Coşkun F, Aypar Ü. Dexmedetomidine and postoperative shivering in patients undergoing elective abdominal hysterectomy. European journal of anaesthesiology 2008; 25(5):357-64.
  18. Bozgeyik S, Mizrak A, Kılıç E, Yendi F, Ugur BK. The effects of preemptive tramadol and dexmedetomidine on shivering during arthroscopy. Saudi journal of anaesthesia 2014; 8(2):238.
  19. Zeb A, Khan ZU, Jan RU, Zeb A, Khan P, Khan SU. Prevalence of Post-Anaesthesia, Shivering in Elective Spinal Surgery & Role of Tramadol in its Control. Ophthalmology Update 2021; 19(2):78-81.
  20. Afonso J, Reis F. Dexmedetomidina: rol actual en anestesia y cuidados intensivos. Revista Brasileira de Anestesiologia 2012; 62:125-33.
  21. Azami-Aghdash S, Ghojazadeh M, Dehdilani N, Mohammadi M. Prevalence and causes of cesarean section in Iran: systematic review and meta-analysis. Iranian journal of public health 2014; 43(5):545.
  22. Luggya TS, Kabuye RN, Mijumbi C, Tindimwebwa JB, Kintu A. Prevalence, associated factors and treatment of post spinal shivering in a Sub-Saharan tertiary hospital: a prospective observational study. BMC anesthesiology 2016; 16(1):1-5.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 25, Issue 6
August 2022
Pages 52-60

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