Moeen S M, Moeen A M
Department of Anesthesiology and Intensive Care, Assiut University, Asyut, Egypt.
Asyut Urology and Nephrology Hospital, Assiut University, Asyut, Egypt.
Acta Anaesthesiol Scand. 2017 Aug;61(7):749-757. doi: 10.1111/aas.12920. Epub 2017 Jun 18.
Shivering is a common complication after spinal anesthesia. Also, during transurethral prostatectomy a large amount of irrigating fluids is used which may cause hypothermia and shivering. We hypothesized that intrathecal dexamethasone could effectively attenuate post-spinal shivering following transurethral prostatectomy as intrathecal meperidine.
Ninety male patients, ASA II-III, 50-75 years old were included in this prospective and randomized double-blind study. Patients were divided into three equal groups; Group D received 8 mg dexamethasone, Group M received 0.2 mg/kg meperidine, and Group C received 2 ml of normal saline, each in addition to intrathecal hyperbaric bupivacaine 0.5%. Shivering incidence, intensity and recurrence, dose of IV meperidine required to treat shivering, and adverse events were recorded for 150 min after the start of spinal anesthesia.
The number of patients with shivering was higher in Group C (13) than in Group D (2) and Group M (3) with no differences between Group D and M; P = 0.001. Intensity and recurrence of shivering and dose of IV meperidine used to treat shivering were higher in Group C compared to Group D and Group M; P = 0.01, P = 0.064, and P = 0.004, respectively. Adverse events were not different between groups except sedation and pruritus which occurred only in Group M compared to Group D and Group C; P = 0.005 and P = 0.001, respectively.
Intrathecal dexamethasone was as effective as intrathecal meperidine in attenuation of shivering compared to placebo in patients scheduled for prostate surgery under spinal anesthesia with less adverse events.
寒战是脊髓麻醉后常见的并发症。此外，经尿道前列腺切除术期间会使用大量冲洗液，这可能导致体温过低和寒战。我们推测，鞘内注射地塞米松可像鞘内注射哌替啶一样有效减轻经尿道前列腺切除术后脊髓麻醉后的寒战。
本前瞻性随机双盲研究纳入了90例年龄在50 - 75岁、ASA II - III级的男性患者。患者被分为三组，每组人数相等；D组接受8毫克地塞米松，M组接受0.2毫克/千克哌替啶，C组接受2毫升生理盐水，每组均在鞘内注射0.5%的高比重布比卡因基础上给药。记录脊髓麻醉开始后150分钟内的寒战发生率、强度和复发情况、治疗寒战所需的静脉注射哌替啶剂量以及不良事件。
C组（13例）寒战患者数量高于D组（2例）和M组（3例），D组和M组之间无差异；P = 0.001。与D组和M组相比，C组寒战的强度和复发情况以及用于治疗寒战的静脉注射哌替啶剂量更高；分别为P = 0.01、P = 0.064和P = 0.004。除了仅在M组出现的镇静和瘙痒外，各组不良事件无差异，与D组和C组相比，M组的镇静和瘙痒发生率分别为P = 0.005和P = 0.001。
在脊髓麻醉下行前列腺手术的患者中，与安慰剂相比，鞘内注射地塞米松在减轻寒战方面与鞘内注射哌替啶效果相当，且不良事件更少。
