A randomized, comparative study of prophylactic intravenous acetaminophen, dexamethasone and pethidine regarding the incidence of post spinal anesthesia shivering in lower limb orthopedic surgeries

  • Mohamed Medhat Moustafa Kamal Nouh
  • Galal Adel Mohamed Abd Elrehiem Elkadi
  • Eman Mohamed Kamal Aboseif
  • Faisal Said Abd El Hamid
  • Marwa Mostafa Mohamed Ali Mowafi
DOI: https://doi.org/10.35975/apic.v27i2.2182
Keywords: Post spinal, Shivering, Pethidine, Dexamethasone, Acetaminophen

Abstract

ABSTRACT

Background: Currently, there is a lack of an established standard or protocol for the management of post-spinal anesthesia shivering (PSAS). We compared the efficacy of intravenous use of three drugs, e.g., acetaminophen, dexamethasone, and pethidine in prevention of PSAS.

Methodology: We included 108 patients who were randomly assigned to three equal groups of 36 patients each. Group A patients received pethidine infusion at 0.5 mg/kg; Group B patients were infused with acetaminophen 15 mg/kg and Group C was given dexamethasone infusion at 0.1 mg/kg. The degree of shivering at its onset was determined using the Bedside Shivering Assessment Scale (BSAS). Data was analyzed using Statistical Package for Social Science (SPSS) version 22.

Results: PSAS was observed in 10 (27.7 %) patients in Group A vs. 14 (38.8 %) patients in Group B (P = 0.32), and 21 (58.3 %) patients of Group C (P = 0.01). The P-value between B vs C was 0.10, and between all the groups was 0.03. The BSAS score was 26 in Group A (75% patients out of 36 did not develop shivering), 22 in Group B, and 15 in Group C. The P-value between A vs. B was 0.01, A vs. C = 0.01, B vs. C = 0.12, and between all groups was 0.02.

Conclusion: Aacetaminophen was more effective than dexamethasone, while pethidine was more effective than both, acetaminophen as well as dexamethasone, in decreasing the incidence of post-spinal anesthesia shivering.

Trial Registry: ClinicalTrials.gov ID: NCT05284409

Abbreviations:  ASA - American Society of Anesthesiologists; BSAS - Bedside Shivering Assessment Scale; PSAS - Post-spinal anesthesia shivering

Key words: Post spinal, Shivering; Pethidine; Dexamethasone; Acetaminophen

Citation: Kamal Nouh MMM, Abd Elrehiem Elkadi GAM, Aboseif EMK, Abd El Hamid FS, Mowafi MMMA. A randomized, comparative study of prophylactic intravenous acetaminophen, dexamethasone and pethidine regarding the incidence of post spinal anesthesia shivering in lower limb orthopedic surgeries. pain intensive care 2023;27(1):185−190; DOI: 10.35975/apic.v27i2.2182

Received: January 14, 2023; Reviewed: February 06, 2023; Accepted: February 13, 2023

Author Biographies

Mohamed Medhat Moustafa Kamal Nouh

Assistant Lecturer of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University, Nasr City, Cairo, Egypt.

Galal Adel Mohamed Abd Elrehiem Elkadi

Professor of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University, Nasr City, Cairo, Egypt

Eman Mohamed Kamal Aboseif

Professor of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University, Nasr City, Cairo, Egypt

Faisal Said Abd El Hamid

MD, Lecturer of Anesthesia, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University, Nasr City, Cairo, Egypt

Marwa Mostafa Mohamed Ali Mowafi

MD, Lecturer of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Nasr City, Cairo, Egypt

Published
04-04-2023
How to Cite
Kamal Nouh, M. M., Elrehiem Elkadi, G. A., Aboseif, E., El Hamid, F. S., & Ali Mowafi, M. M. (2023). A randomized, comparative study of prophylactic intravenous acetaminophen, dexamethasone and pethidine regarding the incidence of post spinal anesthesia shivering in lower limb orthopedic surgeries. Anaesthesia, Pain & Intensive Care, 27(2), 185-190. https://doi.org/10.35975/apic.v27i2.2182
Issue
Vol 27 No 2 (2023): April 2023
Section
ORIGINAL RESEARCH