Tohme Joanna, Chehade Joan, Abou Zeid Hicham, Mattar Rhea, Naccache Nicole, Jabbour Khalil, Ismail Mohammad Ali, Dagher Christine
Department of Anesthesia and Critical Care, Hôtel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon.
Department of Anesthesia and Critical Care, Hôtel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon.
Braz J Anesthesiol. 2025 Jun 11;75(5):844650. doi: 10.1016/j.bjane.2025.844650.
Post Spinal Anesthesia Shivering (PSAS) is common and linked to increased morbidity. While various methods exist to prevent it, no study has compared Nefopam and Ondansetron. This study aims to compare Ondansetron and Nefopam in preventing PSAS.
A prospective, randomized, controlled, and double-blind trial was conducted in the operating room of a tertiary university hospital from April 5, 2021 to April 30, 2022. It included patients aged between 18 and 65 years scheduled for surgery under spinal anesthesia. Patients received either 8 mg of Ondansetron or 20 mg of Nefopam administered intravenously over 30 min before spinal anesthesia. Main outcome measures included the number and grades of shivering episodes post spinal anesthesia at 15-minute intervals until post-anesthesia care unit discharge. Secondary outcomes included number of episodes of hypotension, bradycardia, nausea and/or vomiting. Tympanic temperature and pain at the injection site were also recorded.
The study included 150 patients, evenly divided between the two groups. The Ondansetron group had a higher incidence of shivering compared to the Nefopam group (23.9 % vs. 16 %; p = 0.038), as well as higher incidences of hypotension (16 % vs. 5.3 %; p = 0.035) and bradycardia (13.3 % vs. 2.7 %; p = 0.016). The Ondansetron group had a significantly lower incidence of nausea and vomiting (12 % vs. 1.3 %; p = 0.010). More patients in the Nefopam group (45.3 %) reported pain during drug infusion.
Nefopam seems to be more effective than Ondansetron in preventing PSAS with fewer cardiovascular side effects. However, Ondansetron reduces the incidence of nausea and vomiting and causes no pain during administration.
脊髓麻醉后寒战（PSAS）很常见，且与发病率增加有关。虽然有多种方法可预防PSAS，但尚无研究比较奈福泮和昂丹司琼。本研究旨在比较昂丹司琼和奈福泮预防PSAS的效果。
于2021年4月5日至2022年4月30日在一所三级大学医院的手术室进行了一项前瞻性、随机、对照、双盲试验。纳入年龄在18至65岁之间计划接受脊髓麻醉手术的患者。患者在脊髓麻醉前30分钟内静脉注射8毫克昂丹司琼或20毫克奈福泮。主要观察指标包括脊髓麻醉后每隔15分钟直至麻醉后护理单元出院时的寒战发作次数和分级。次要观察指标包括低血压、心动过缓、恶心和/或呕吐发作次数。还记录了鼓膜温度和注射部位疼痛情况。
该研究纳入了150例患者，两组各75例。与奈福泮组相比，昂丹司琼组的寒战发生率更高（23.9%对16%；p = 0.038），低血压（16%对5.3%；p = 0.035）和心动过缓（13.3%对2.7%；p = 0.016）的发生率也更高。昂丹司琼组恶心和呕吐的发生率显著较低（12%对1.3%；p = 0.010）。奈福泮组更多患者（45.3%）报告在药物输注期间有疼痛。
奈福泮在预防PSAS方面似乎比昂丹司琼更有效，且心血管副作用更少。然而，昂丹司琼可降低恶心和呕吐的发生率，且给药期间无疼痛。
