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Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery; (RCT).
BMC Anesthesiol. 2019 10 24; 19(1):190.BA

Abstract

BACKGROUND

Hypothermia and shivering are common complications after spinal anaesthesia, especially after uroscopic procedures in which large amounts of cold intraluminal irrigation fluids are used. Magnesium sulfate and dexmedetomidine are the most effective adjuvants with the least side effects. The aim of this study was to compare the effects of intrathecal dexmedetomidine versus intrathecal magnesium sulfate on the prevention of post-spinal anaesthesia shivering.

METHODS

This prospective randomized, double-blinded controlled study included 105 patients who were scheduled for uroscopic surgery at the Kasr El-Aini Hospital. The patients were randomly allocated into three groups. Group C (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 0.5 ml of normal saline, Group M (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 25 mg of magnesium sulfate in 0.5 ml saline, and Group D (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 5 μg of dexmedetomidine in 0.5 ml saline. The primary outcomes were the incidence and intensity of shivering. 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. Hypothermia did not occur in any of the patients. The three groups were comparable regarding the occurrence of nausea, vomiting, bradycardia and hypotension. All the patients in group C, 32 patients in group M and 33 patients in group D had a sedation score of 2. Three patients in group M and 2 patients in group D had a sedation score of 3.

CONCLUSIONS

Intrathecal injections of both dexmedetomidine and magnesium sulfate were effective in reducing the incidence of post-spinal anaesthesia shivering. Therefore, we encourage the use of magnesium sulfate, as it is more physiologically available, more readily available in most operating theatres and much less expensive than dexmedetomidine.

TRIAL REGISTRATION

Clinical trial registration ID: Pan African Clinical Trial Registry (PACTR) Trial Number PACTR201801003001727 ; January 2018, "retrospectively registered".

Authors+Show Affiliations

Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt.El Sahel Teaching Hospital, Cairo, Egypt.Anesthesia Department, National Cancer Institute, Cairo University, Cairo, Egypt.Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt.Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt.Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt.Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt.Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt.Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt.Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt.Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt.Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt. bassantmohamed197@yahoo.com.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

31651246

Citation

Omar, Heba, et al. "Comparative Study Between Intrathecal Dexmedetomidine and Intrathecal Magnesium Sulfate for the Prevention of Post-spinal Anaesthesia Shivering in Uroscopic Surgery; (RCT)." BMC Anesthesiology, vol. 19, no. 1, 2019, p. 190.
Omar H, Aboella WA, Hassan MM, et al. Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery; (RCT). BMC Anesthesiol. 2019;19(1):190.
Omar, H., Aboella, W. A., Hassan, M. M., Hassan, A., Hassan, P., Elshall, A., Khaled, D., Mostafa, M., Tawadros, P. Z., Hossam Eldin, M., Wedad, M., & Abdelhamid, B. M. (2019). Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery; (RCT). BMC Anesthesiology, 19(1), 190. https://doi.org/10.1186/s12871-019-0853-0
Omar H, et al. Comparative Study Between Intrathecal Dexmedetomidine and Intrathecal Magnesium Sulfate for the Prevention of Post-spinal Anaesthesia Shivering in Uroscopic Surgery; (RCT). BMC Anesthesiol. 2019 10 24;19(1):190. PubMed PMID: 31651246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery; (RCT). AU - Omar,Heba, AU - Aboella,Wessam Adel, AU - Hassan,Mohammed Mahmoud, AU - Hassan,Amany, AU - Hassan,Passaint, AU - Elshall,Ahmed, AU - Khaled,Dalia, AU - Mostafa,Maha, AU - Tawadros,Pierre Zarif, AU - Hossam Eldin,Mona, AU - Wedad,Mai, AU - Abdelhamid,Bassant Mohamed, Y1 - 2019/10/24/ PY - 2018/10/31/received PY - 2019/09/20/accepted PY - 2019/10/26/entrez PY - 2019/10/28/pubmed PY - 2020/7/2/medline KW - Dexmedetomidine KW - Magnesium KW - Shivering KW - Spinal SP - 190 EP - 190 JF - BMC anesthesiology JO - BMC Anesthesiol VL - 19 IS - 1 N2 - BACKGROUND: Hypothermia and shivering are common complications after spinal anaesthesia, especially after uroscopic procedures in which large amounts of cold intraluminal irrigation fluids are used. Magnesium sulfate and dexmedetomidine are the most effective adjuvants with the least side effects. The aim of this study was to compare the effects of intrathecal dexmedetomidine versus intrathecal magnesium sulfate on the prevention of post-spinal anaesthesia shivering. METHODS: This prospective randomized, double-blinded controlled study included 105 patients who were scheduled for uroscopic surgery at the Kasr El-Aini Hospital. The patients were randomly allocated into three groups. Group C (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 0.5 ml of normal saline, Group M (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 25 mg of magnesium sulfate in 0.5 ml saline, and Group D (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 5 μg of dexmedetomidine in 0.5 ml saline. The primary outcomes were the incidence and intensity of shivering. 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. Hypothermia did not occur in any of the patients. The three groups were comparable regarding the occurrence of nausea, vomiting, bradycardia and hypotension. All the patients in group C, 32 patients in group M and 33 patients in group D had a sedation score of 2. Three patients in group M and 2 patients in group D had a sedation score of 3. CONCLUSIONS: Intrathecal injections of both dexmedetomidine and magnesium sulfate were effective in reducing the incidence of post-spinal anaesthesia shivering. Therefore, we encourage the use of magnesium sulfate, as it is more physiologically available, more readily available in most operating theatres and much less expensive than dexmedetomidine. TRIAL REGISTRATION: Clinical trial registration ID: Pan African Clinical Trial Registry (PACTR) Trial Number PACTR201801003001727 ; January 2018, "retrospectively registered". SN - 1471-2253 UR - https://www.unboundmedicine.com/medline/citation/31651246/Comparative_study_between_intrathecal_dexmedetomidine_and_intrathecal_magnesium_sulfate_for_the_prevention_of_post_spinal_anaesthesia_shivering_in_uroscopic_surgery L2 - https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-019-0853-0 DB - PRIME DP - Unbound Medicine ER -