Department of Pharmacology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan.
J Ayub Med Coll Abbottabad. 2023 Oct-Dec;35(4):530-533. doi: 10.55519/JAMC-04-11651.
Shivering is one of the most common adverse outcomes associated with the administration of spinal anaesthesia, which, when clinically relevant, leads to numerous detrimental effects on the human body. Hence, its management becomes imperative. Meperidine, an opioid analgesic, is the drug of choice for this condition. However, the use of meperidine is controversial, as it carries the devastating adverse effect of respiratory depression. We explored the role of granisetron, a 5HT3 antagonist and a commonly used antiemetic premedication, in minimising the incidence of post-spinal shivering and decreasing the use of meperidine as a rescue drug.
Overall, 160 parturient patients, between the ages 18-50, undergoing uncomplicated, elective caesarean section, were enrolled in the study, and randomized into two groups with 80 participants each: Group A received 3ml of normal saline, and Group B was administered 3 mg granisetron,15 minutes before spinal anaesthesia institution. Incidence of clinically relevant shivering (score of 3 or more) was noted, and it was recorded whether meperidine was used or not.
67.5% of participants in Group A, and 32.5% of patients in Group B, experienced clinically relevant shivering, with 62.5% of patients in Group A and 28.75% in Group B warranting the use of meperidine. There was a statistically significant difference between the two groups in terms of incidence of clinically relevant shivering, and meperidine consumption (p-value <0.001).
Premedication with 3 mg granisetron effectively attenuates the occurrence of post-spinal shivering and, hence, lowers the requirement of meperidine as rescue medication.
寒战是椎管内麻醉相关的最常见的不良反应之一，当具有临床意义时，会对人体造成许多不利影响。因此，对其进行管理至关重要。哌替啶是一种阿片类镇痛药，是治疗这种情况的首选药物。然而，哌替啶的使用存在争议，因为它会产生呼吸抑制等毁灭性的不良反应。我们探讨了 5-HT3 拮抗剂格兰司琼在减少椎管内麻醉后寒战的发生以及减少作为抢救药物的哌替啶的使用中的作用。
共有 160 名年龄在 18-50 岁之间的择期行剖宫产术的产妇参与了这项研究，她们被随机分为两组，每组 80 名患者：A 组接受 3ml 生理盐水，B 组在椎管内麻醉前 15 分钟给予 3mg 格兰司琼。记录出现临床相关寒战（评分 3 分或以上）的患者比例，以及是否使用了哌替啶。
A 组有 67.5%的患者出现临床相关寒战，B 组有 32.5%的患者出现临床相关寒战，A 组有 62.5%的患者需要使用哌替啶，B 组有 28.75%的患者需要使用哌替啶。两组在出现临床相关寒战和使用哌替啶的发生率方面存在统计学差异（p 值<0.001）。
在椎管内麻醉前使用 3mg 格兰司琼可有效减轻术后寒战的发生，从而降低对哌替啶作为抢救药物的需求。
