Intrathecal Dexmedetomidine Vs Intravenous Dexmedetomidine as Prophylaxis of Post-Spinal Anesthesia Shivering in Urologic Endoscopic Surgery – A Randomized Prospective Trial

Abstract

Background: In the realm of urologic endoscopic surgery, which frequently encompasses procedures conducted under spinal anesthesia, the identification of efficacious strategies to mitigate the occurrence of post-spinal anesthesia shivering (PSAS) holds paramount significance.

The use of dexmedetomidine, a pharmaceutical drug that acts as an α2-adrenergic agonist, has become increasingly popular in the prevention of postoperative shivering and anaesthesia- induced shivering, both in intrathecal and intravenous route. The main aim of this study is to investigate the efficacy and safety of intrathecal dexmedetomidine in comparison to intravenous dexmedetomidine as a preventive measure against postoperative shivering and anaesthesia - induced shivering (PSAS) in urologic endoscopic surgery.

Methods: This randomized double blind study was carried out in patients posted for elective urologic endoscopic surgeries under spinal anaesthesia. A total of 60 patients were enrolled and arbitrarily split up into 2 groups: Group A and B. Spinal block was administered in both group under standard protocol.

Group A received Intrathecal 10mcg dexmedetomidine(0.1ml) + hyperbaric bupivacaine 0.5%(3ml) and intravenous 10ml saline immediately after block over 10min, Group B was given Intrathecal 0.1ml saline + hyperbaric 0.5% bupivacaine(3ml) and intravenous 0.75mcg/kg dexmedetomidine in 10ml saline immediately after block over 10min. Onset and duration of motor and sensory blockade, shivering incidence and scores, hemodynamic variables were recorded

Results: The present study demonstrates a notable decrease in the occurrence of post-spinal shivering at 15, 30, and 45 minutes among patients in the GROUP A as opposed to those in GROUP B (P=0.03 at 15mins, P=0.03 at 30mins, P=0.001 at 45mins). The incidence of shivering in group A was 12/30 patients(40%) compared with group B 23/30 patients(76%). The mean duration of the sensory and motor block of patients in GROUP A(208.67±14.98 mins and 180.07 ±13.06 mins) was more as compared to GROUP B(194.40±18.62 mins and 168.20±19.90 mins) and there was a significant difference between GROUP A and GROUP B(P=0.002 sensory block and P=0.008 motor block). There was no significant difference in hemodynamic variables between both groups.

Conclusion: We concluded that intrathecal dexmedetomidine has superior efficacy in controlling post-spinal shivering in immediate postoperative phase compared to intravenous route with no significant adverse effects.