Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison Study of Preemptive Effect of Intratechal Fentanyl with Intravenous Ondansetron, Dexamethasone, and Dexamethasone plus Ondansetron on Shivering during Surgeries under Spinal Anesthesia with Bupivacaine

Document Type : Original Article (s)

Authors
Mohammadreza Safavi 1
Azim Honarmand 1
Mina Barzegar 2
1 Professor, Department of Anesthesiology, School of Medicine AND Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Previous studies showed that dexamethasone and ondansetron had effect on preventing shivering in surgeries under spinal anesthesia but comparison of the two drugs was not studied. This study aimed to compare preemptive effect of intratechal fentanyl with intravenous ondansetron, dexamethasone, and dexamethasone plus ondansetron on shivering during surgeries under spinal anesthesia with bupivacaine.Methods: In a clinical trial study, 185 patients under surgeries with spinal anesthesia were randomly divided in 5 groups of receiving 25 µg intratechal fentanyl, 4 mg intravenous ondansetron, 0.1 mg/kg intravenous dexamethasone, 0.1 mg/kg intravenous dexamethasone plus 4 mg intravenous ondansetron, and 4 ml intravenous normal saline in a bolus dose. The incidence of shivering during surgery was compared between the 5 groups.Findings: Mean shivering scale during surgery and recovery time in control, dexamethasone plus ondansetron, ondansetron alone, dexamethasone alone, and fentanyl groups were 1.30 ± 0.33, 1.01 ± 0.04, 1.15 ± 0.20, 1.04 ± 0.07 and 1.12 ± 0.15, respectively. Shivering intensity in control group was higher and in dexamethasone plus ondansetron was lower than others significantly (P < 0.001).Conclusion: Using dexamethasone plus ondansetron have more effect on decreasing shivering during and after the surgery. In addition, this compound has not adverse effect on hemodynamic parameters.
Keywords
Shivering
Bupivacaine
Dexamethasone
Ondansetron
Anesthesia
Spinal
  1. Ozaki M, Kurz A, Sessler DI, Lenhardt R, Schroeder M, Moayeri A, et al. Thermoregulatory thresholds during epidural and spinal anesthesia. Anesthesiology 1994; 81(2): 282-8.
  2. Jeon YT, Jeon YS, Kim YC, Bahk JH, Do SH, Lim YJ. Intrathecal clonidine does not reduce post-spinal shivering. Acta Anaesthesiol Scand 2005; 49(10): 1509-13.
  3. Ciofolo MJ, Clergue F, Devilliers C, Ben Ammar M, Viars P. Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia. Anesthesiology 1989; 70(5): 737-41.
  4. Dal D, Kose A, Honca M, Akinci SB, Basgul E, Aypar U. Efficacy of prophylactic ketamine in preventing postoperative shivering. Br J Anaesth 2005; 95(2): 189-92.
  5. Glosten B, Hynson J, Sessler DI, McGuire J. Preanesthetic skin-surface warming reduces redistribution hypothermia caused by epidural block. Anesth Analg 1993; 77(3): 488-93.
  6. Singh P, Dimitriou V, Mahajan RP, Crossley AW. Double-blind comparison between doxapram and pethidine in the treatment of postanaesthetic shivering. Br J Anaesth 1993; 71(5): 685-8.
  7. Kurz M, Belani KG, Sessler DI, Kurz A, Larson MD, Schroeder M, et al. Naloxone, meperidine, and shivering. Anesthesiology 1993; 79(6): 1193-201.
  8. de Witte J, Deloof T, de Veylder J, Housmans PR. Tramadol in the treatment of postanesthetic shivering. Acta Anaesthesiol Scand 1997; 41(4): 506-10.
  9. Chow TC, Cho PH. The influence of small dose intrathecal fentanyl on shivering during transurethral resection of prostate under spinal anesthesia. Acta Anaesthesiol Sin 1994; 32(3): 165-70. [In Japanese].
  10. Sadegh A, Tazeh-Kand NF, Eslami B. Intrathecal fentanyl for prevention of shivering in spinal anesthesia in cesarean section. Med J Islam Repub Iran 2012; 26(2): 85-9.
  11. Techanivate A, Urusopone P, Kiatgungwanglia P, Kosawiboonpol R. Intrathecal fentanyl in spinal anesthesia for appendectomy. J Med Assoc Thai 2004; 87(5): 525-30.
  12. Alfonsi P. Postanaesthetic shivering: epidemiology, pathophysiology, and approaches to prevention and management. Drugs 2001; 61(15): 2193-205.
  13. Gardner C, Perren M. Inhibition of anaesthetic-induced emesis by a NK1 or 5-HT3 receptor antagonist in the house musk shrew, Suncus murinus. Neuropharmacology 1998; 37(12): 1643-4.
  14. Powell RM, Buggy DJ. Ondansetron given before induction of anesthesia reduces shivering after general anesthesia. Anesth Analg 2000; 90(6): 1423-7.
  15. Khosravi A, Moinvaziri MT, Esmaili MH, Farbood AR, Nik-khoo H, Yarmohammadi H. Treatment of postoperative shivering with dexamethasone: A prospective randomized clinical trial. Iran J Med Sci 2002; 27(1): 15-7.
  16. Entezariasl M, Isazadehfar K. Dexamethasone for prevention of postoperative shivering: a randomized double-blind comparison with pethidine. Int J Prev Med 2013; 4(7): 818-24.
  17. Garousi L, Entezari M, Mohamadian Ardi A. Comparison the effect of ondansetron and meperidine in the prevention of post operative shivering after general anesthesia [MD Thesis]. Aradbil, Iran: Ardabil University of Medical Sciences; 2007. [In Persian].
  18. Gholamhoseinzadeh Tabasi Z. Comparison effect of ondansetrone alone and ondansetron plus dexamethason on post operative shivering among patients under sesaran section with spinal anesthesia. [MD Thesis]. Tehran, Iran: Tehran University of Medical Sciences; 2006. [In Persian].
  19. Moinvaziri MT, Khosravi A. Comparison effect of dexamethason on decrease of postoperative shivering in patients under general surgeries. J Iran Society Anesthesiol Intensive Care 2001; 21(35-36); 17-21. [In Persian].
Journal of Isfahan Medical School
Volume 35, Issue 452 - Serial Number 452
September and October 2017
Pages 1476-1482

  • Receive Date 27 May 2017
  • Accept Date 06 April 2022