Department of Anesthesia and Intensive Care, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
Community Medicine Department, National Research Centre, Cairo, Egypt.
BMC Anesthesiol. 2021 Oct 30;21(1):262. doi: 10.1186/s12871-021-01483-7.
Shivering is known to be a frequent complication in patients undergoing surgery under neuraxial anesthesia with incidence of 40-70%. Although many pharmacological agents have been used to treat or prevent postspinal anesthesia shivering (PSAS), the ideal treatment wasn't found. This study evaluated the efficacy of paracetamol and dexamethasone to prevent PSAS in patients undergoing lower abdominal and lower limb surgeries.
Three hundred patients scheduled for surgeries under spinal anesthesia (SA) were allocated into three equal groups to receive a single preoperative dose of oral paracetamol 1 g (P group), dexamethasone 8 mg intravenous infusion (IVI) in 100 ml normal saline (D group) or placebo (C group), 2 h preoperatively, in a randomized, double-blind trial. The primary endpoint was the incidence of clinically significant PSAS. Secondary endpoints included shivering score, the change in hemodynamics, adverse events (e.g., nausea, vomiting and pruritis) and patients` satisfaction.
Clinically significant PSAS was recorded as (15%) in P group, (40%) in D group and (77%) in C group (P < 0.001). The mean blood pressure values obtained over a 5-25 min observation period were significantly higher in the D group (P < 0.001). Core temperature 90 min after SA was significantly lower in the 3 groups compared to prespinal values (P < 0.001). Nausea, vomiting and pruritis were significantly higher in the C group (P < 0.001). P and D groups were superior to C group regarding the patients' satisfaction score (P < 0.001).
Paracetamol and dexamethasone were effective in prevention of PSAS in patients undergoing lower abdominal and lower limb surgeries compared to placebo controls.
ClinicalTrials.gov Identifier: NCT03679065 / Registered 20 September 2018 - Retrospectively registered, http://www.ClinicalTrial.gov .
在接受椎管内麻醉的患者中，寒战是一种常见的并发症，发生率为 40-70%。尽管已经使用了许多药物来治疗或预防椎管麻醉后寒战（PSAS），但仍未找到理想的治疗方法。本研究评估了对乙酰氨基酚和地塞米松预防下腹部和下肢手术患者 PSAS 的疗效。
将 300 名计划接受脊髓麻醉（SA）的患者随机分为三组，分别接受单次术前口服对乙酰氨基酚 1g（P 组）、静脉输注生理盐水 100ml 中 8mg 地塞米松（D 组）或安慰剂（C 组），术前 2h 给药。主要终点是临床显著 PSAS 的发生率。次要终点包括寒战评分、血液动力学变化、不良反应（如恶心、呕吐和瘙痒）和患者满意度。
P 组、D 组和 C 组的临床显著 PSAS 发生率分别为（15%）、（40%）和（77%）（P<0.001）。D 组在 5-25min 观察期内获得的平均血压值明显高于其他两组（P<0.001）。与术前相比，3 组 SA 后 90min 的核心温度均明显降低（P<0.001）。C 组恶心、呕吐和瘙痒的发生率明显高于其他两组（P<0.001）。与 C 组相比，P 组和 D 组患者的满意度评分更高（P<0.001）。
与安慰剂对照相比，对乙酰氨基酚和地塞米松在预防下腹部和下肢手术患者 PSAS 方面有效。
ClinicalTrials.gov 标识符：NCT03679065 / 2018 年 9 月 20 日注册-回顾性注册，http://www.ClinicalTrial.gov。
