Post Spinal Anesthesia Shivering
Conditions
Keywords
dexmedetomidine-adductor canal block
Brief summary
Shivering increases the cardiac and systemic energy expenditure, oxygen consumption and carbon dioxide production. Definitive prevention and treatment of shivering is necessary to decrease the related complications and increase post-anesthetic comfort.
Detailed description
Dexmedetomidine a highly selective α2 adrenergic agonist used effectively as a safe analgesic via different routes and mechanisms, including intravenous (i.v.), neuraxial and perineural routes. Dexmedetomidine has been used for prevent shivering but, the results of its efficacy is still controversy. No studies to date have investigated the best administration route of dexmedetomidine to dominantly prevent the occurrence of shivering after spinal anesthesia or associated with the least grade. This prospective, randomized, double blinded study was designed to investigate the best administrative route of dexmedetomidine firstly, as a preventive of neuraxial shivering and secondly as adjunctive analgesic. The incidence of post-spinal anesthesia shivering was the primary outcome. Perioperative hemodynamics, postoperative pain scores during rest and at 45-degree flexion of the knee, the analgesic duration, the first postoperative day analgesic consumption, the sedation score and early ambulation ability were the secondary outcomes.
Interventions
adductor-canal-blockade with 20 mL 0.25% levobupivacaine plus 1 mL normal saline while, the intravenous solution; consists of 0.5µg.kg-1 dexmedetomidine diluted in 20 mL normal saline
DRUGadductor canal block dexmedetomidine
adductor-canal-blockade with 20 mL 0.25% levobupivacaine plus 1 mL of 0.5µg.kg-1 dexmedetomidineline while, the intravenous solution;consists of 20 mL normal saline
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
The study anesthetic drugs both for adductor-canal-blockade and for intravenous infusion were prepared according to the group by an anesthetist who was not involved in its injection or the perioperative assessment
Eligibility
Sex/Gender
ALL
Age
19 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* adult patients * both genders * American Society of Anesthesiologists physical status I and II * scheduled for unilateral primary TKA under spinal anesthesia
Exclusion criteria
* chronic opioid use * known allergy to the used drugs * any contraindications to regional anesthesia like; patient refusal, coagulopathy, neuropathy or infection at the injection site
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| incidence of post-spinal anesthesia shivering | up to 24 hours | 5-point scale (0= no shivering, 1 =piloerection or peripheral vasoconstriction but no visible shivering; 2 =muscular activity in only one muscle group; 3 =muscular activity in more than one muscle group but not generalized and 4 = shivering involving the whole body) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| total cumulative doses of rescue analgesic | after the first postoperative 24 hours | given when visual analog scale for pain ≥ 40 |
| Modified Ramsay sedation scale | after 0.5 hour from adductor-canal-blockade then, 2, 4, 6, 8, 10, 12 and 24 hours postoperatively | 1. Awake and alert, minimal or no cognitive impairment 2. Awake but tranquil, purposeful responses to verbal commands at a conversational level 3. Appears asleep, purposeful response to verbal commands at a conversational level 4. Appears asleep, purposeful responses to commands but at a louder than conversational level, requiring light glabellar tap, or both 5. Asleep, sluggish purposeful responses only to loud verbal commands, strong glabellar tap, or both 6. Asleep, sluggish purposeful responses only to painful stimuli 7. Asleep, reflex withdrawal to painful stimuli only 8. Unresponsive to external stimuli, including pain |
| The analgesic duration | during the first postoperative 24 hours | the time from adductor-canal-blockade injection till the first of postoperative dose of rescue analgesic |
| Heart rate | every 15 minutes after spinal anesthesia till the end of the surgery then at 0.5, 1, 3, 6, 12 hours postoperative | beat per minute |
| postoperative pain | preoperative, 2, 4, 6, 8, 10, 12 and 24 hours postoperatively | visual analog scale for pain (0 mm= no pain, and 100 = the worst possible pain) |
| non-invasive arterial blood pressure | every 15 minutes after spinal anesthesia till the end of the surgery then at 0.5, 1, 3, 6, 12 hours postoperative | mmHg |
Countries
Egypt
Outcome results
None listed