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Safety and Efficacy of Dexmedetomidine in Treating Post Spinal Anesthesia Shivering: A Randomized Clinically Controlled Dose-Finding Trial.
Pain Physician. 2016 05; 19(4):243-53.PP

Abstract

BACKGROUND

The optimum dose of dexmedetomidine for shivering control with the least hemodynamic derangements is still under research.

OBJECTIVE

To compare the efficacy, hemodynamic and side effects of dexmedetomidine in 3 different doses with those of meperidine for the treatment of shivering in patients undergoing spinal anesthesia for minor elective lower abdominal surgery.

STUDY DESIGN

Prospective double-blind randomized clinically controlled study.

SETTING

University hospital.

METHODS

One hundred twenty patients who developed shivering under spinal anesthesia.On shivering, patients were randomly allocated to receive an intravenous 2 mL bolus dose of meperidine 0.4 mg/kg (meperidine group, n = 30), dexmedetomidine 0.5 µg/kg (DEX I group, n = 30), 0.3 µg/kg (DEX II group, n = 30), or 0.2µg/kg (DEX III group, n = 30). Control of shivering, time taken for cessation of shivering, response rate, recurrence, hemodynamic changes, sedation score, tympanic temperature, and side effects were noted and compared between groups.

RESULTS

The groups were comparable regarding demographic profile, tympanic temperature decline, and shivering onset time (P > 0.05). Lower shivering cessation time (P < 0.001) and higher response rate (P < 0.01) were observed in DEX I and II groups compared with DEX III and meperidine groups, with a nonsignificant difference between DEX I and II groups. Recurrence of shivering activity was higher in DEX III group (36.7%, P < 0.01) compared with DEX I (10%), DEX II (6.7%) and meperidine (16.7%) groups. Lower heart rates, systolic and diastolic blood pressure mean values were recorded in DEX I group (P < 0.05). Nine patients (30%) in DEX I group were in levels 3 - 5 of sedation (P < 0.02) compared with 5 (16.66%), 2 (6.66%), and 4 (13.3) patients in DEX II, DEX III, and meperidine groups, respectively.

LIMITATIONS

This study is limited by its small sample size.

CONCLUSIONS

Among the 3 doses investigated, dexmedetomidine 0.3µg/kg effectively treated shivering associated with spinal anesthesia with modest hemodynamic and sedation effects.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02382432.

KEY WORDS

Dexmedetomidine, hypothermia, shivering, spinal anesthesia.

Authors+Show Affiliations

No affiliation info availableNo affiliation info availableNo affiliation info availableFaculty of Medicine, Assiut University, Assiut, Egypt.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27228512

Citation

Abdel-Ghaffar, Hala Saad, et al. "Safety and Efficacy of Dexmedetomidine in Treating Post Spinal Anesthesia Shivering: a Randomized Clinically Controlled Dose-Finding Trial." Pain Physician, vol. 19, no. 4, 2016, pp. 243-53.
Abdel-Ghaffar HS, Mohamed SA, Fares KM, et al. Safety and Efficacy of Dexmedetomidine in Treating Post Spinal Anesthesia Shivering: A Randomized Clinically Controlled Dose-Finding Trial. Pain Physician. 2016;19(4):243-53.
Abdel-Ghaffar, H. S., Mohamed, S. A., Fares, K. M., & Osman, M. A. (2016). Safety and Efficacy of Dexmedetomidine in Treating Post Spinal Anesthesia Shivering: A Randomized Clinically Controlled Dose-Finding Trial. Pain Physician, 19(4), 243-53.
Abdel-Ghaffar HS, et al. Safety and Efficacy of Dexmedetomidine in Treating Post Spinal Anesthesia Shivering: a Randomized Clinically Controlled Dose-Finding Trial. Pain Physician. 2016;19(4):243-53. PubMed PMID: 27228512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and Efficacy of Dexmedetomidine in Treating Post Spinal Anesthesia Shivering: A Randomized Clinically Controlled Dose-Finding Trial. AU - Abdel-Ghaffar,Hala Saad, AU - Mohamed,Sahar Abd-Elbaky, AU - Fares,Khaled M, AU - Osman,Mohamed Abdel-Kadr, PY - 2016/5/27/entrez PY - 2016/5/27/pubmed PY - 2017/2/14/medline SP - 243 EP - 53 JF - Pain physician JO - Pain Physician VL - 19 IS - 4 N2 - BACKGROUND: The optimum dose of dexmedetomidine for shivering control with the least hemodynamic derangements is still under research. OBJECTIVE: To compare the efficacy, hemodynamic and side effects of dexmedetomidine in 3 different doses with those of meperidine for the treatment of shivering in patients undergoing spinal anesthesia for minor elective lower abdominal surgery. STUDY DESIGN: Prospective double-blind randomized clinically controlled study. SETTING: University hospital. METHODS: One hundred twenty patients who developed shivering under spinal anesthesia.On shivering, patients were randomly allocated to receive an intravenous 2 mL bolus dose of meperidine 0.4 mg/kg (meperidine group, n = 30), dexmedetomidine 0.5 µg/kg (DEX I group, n = 30), 0.3 µg/kg (DEX II group, n = 30), or 0.2µg/kg (DEX III group, n = 30). Control of shivering, time taken for cessation of shivering, response rate, recurrence, hemodynamic changes, sedation score, tympanic temperature, and side effects were noted and compared between groups. RESULTS: The groups were comparable regarding demographic profile, tympanic temperature decline, and shivering onset time (P > 0.05). Lower shivering cessation time (P < 0.001) and higher response rate (P < 0.01) were observed in DEX I and II groups compared with DEX III and meperidine groups, with a nonsignificant difference between DEX I and II groups. Recurrence of shivering activity was higher in DEX III group (36.7%, P < 0.01) compared with DEX I (10%), DEX II (6.7%) and meperidine (16.7%) groups. Lower heart rates, systolic and diastolic blood pressure mean values were recorded in DEX I group (P < 0.05). Nine patients (30%) in DEX I group were in levels 3 - 5 of sedation (P < 0.02) compared with 5 (16.66%), 2 (6.66%), and 4 (13.3) patients in DEX II, DEX III, and meperidine groups, respectively. LIMITATIONS: This study is limited by its small sample size. CONCLUSIONS: Among the 3 doses investigated, dexmedetomidine 0.3µg/kg effectively treated shivering associated with spinal anesthesia with modest hemodynamic and sedation effects. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02382432. KEY WORDS: Dexmedetomidine, hypothermia, shivering, spinal anesthesia. SN - 2150-1149 UR - https://www.unboundmedicine.com/medline/citation/27228512/Safety_and_Efficacy_of_Dexmedetomidine_in_Treating_Post_Spinal_Anesthesia_Shivering:_A_Randomized_Clinically_Controlled_Dose_Finding_Trial_ L2 - http://www.painphysicianjournal.com/linkout?issn=1533-3159&amp;vol=19&amp;page=243 DB - PRIME DP - Unbound Medicine ER -